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Contact Name*

Contact Title*

Institution Name*

If you are a K-12 School, please enter your ESD

Address*

City*

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Building IP Address(es)

Please provide your School’s IPs, Public Library IPs, or any Proxy IPs.

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By checking this box, you submit your information to the Gale Provisioning Team, who will use it for installation purposes, only.

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If you have any questions with this form please email: [email protected] and someone will be able to assist you.

Washington State Library