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| Her Majesty Queen Margrethe II of Denmark, Protector |
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| The Danish Immigrant Museum 2212 Washington Street P.O. Box 470 Elk Horn, Iowa 51531-0470 712.764.7001 © Since 1983; All Rights Reserved |
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| TRANSLATIONS REQUEST FORM Print and complete this form; mail with payment and documents to: The Danish Immigrant Museum Family History & Genealogy Center Translation Requests 4210 Main Street P.O. Box 249 Elk Horn, Iowa 51531-0249 _________________________________________________________________________ Date: _____________________ Your Name: _____________________________________________________ Mailing Address: _________________________________________________ City: _______________________________ State: _________ ZIP: _________ Phone: ___________________________ E.Mail: _______________________ _________________________________________________________________________ Payment Information: Translation Fees: $20 per hour for Museum members; $30 per hour for non-members. Maximum number of hours authorized: _________ Form to be accompanied by a minimum 1-hour retainer. [ ] A check or money order for $ _________ is enclosed. [ ] I authorize my credit card to be billed for $ _______________. MasterCard _______ Visa _______ Card # __________________________________ Exact Name On Card: ________________________________________________ Expiration Date: ___________ Signature: ___________________________________________ (Date) _________ _________________________________________________________________________ Translations Requested: (Provide detailed information.) Number and Type of Document(s): Send copies of documents for translations, rather than original copies. The Danish Immigrant Museum cannot be responsible for original documents. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Additional Details or Comments: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ _________________________________________________________________________ For Office Use Only: Received By: _____________________ Initials: ________________ Date: ____________ Completed By: _____________________ Initials: ________________ Date: ____________ |
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