Town of Burlington 29 Center Street Phone
781.270.1604/1660 Burlington, MA 01803 Fax 781.270.1608 www.burlington.org/archives Office of the Town Clerk, Archives Division Email:
archives@burlmass.org
Jane L. Chew, CMC, Town Clerk Lisa A. Plato, CA
Eleanor M. Gelinas, CMC, Asst. Town Clerk Archivist/Records Manager
DUPLICATION ORDER FORM
________________________________________________ ______________________
Date Phone
(Please Include Area Code)
________________________________________________ ______________________
Name/Institution (If
Applicable) Best
Time to Call
________________________________________________ ______________________
Address Email
(If Available)
________________________________________________________________ q Please
Call or Email Me for Pickup
Address
________________________________________________ q Please Mail
City, State, Zip Code
DESCRIPTION TOTAL#/COST
(Continue on Reverse, If
Necessary)
________________________________________________ q Photocopies ____________
________________________________________________ q Color copies ____________
________________________________________________ q 8 x 10 B&W Photo ____________
________________________________________________ q 8 x 10 Color Photo ____________
________________________________________________ q 8 x 10 Inkjet Print ____________
________________________________________________ q Digital Scan ____________
________________________________________________ q Microfilm ____________
________________________________________________ q Plans and Drawings ____________
________________________________________________ q Mailing Labels ____________
________________________________________________ __________________________________
Date Delivered Signature
Description/notes:
Payment received: $ Date:
Via: q Cash q Check #
q Other: