Form to be completed by publisher and sent with online monograph publications
The information requested is used for archiving and cataloguing Canadian online publications

Date: 

1.  Identification

Publisher name: 
Postal address: 
URL of publisher’s Website: 
Contact name : 
E-mail address:                             	Telephone number:			  Fax number: 

2.  Publication

Title of online publication: 

Date published: 

Is it a revised edition of a publication already archived ?	Yes	No

Is the publication available only online ?		Yes   	No

First author's name in full:				Second author’s name in full: 

Birthdate (yyyy-mm-dd):					Birthdate(yyyy-mm-dd): 
Canadian citizen	Yes	No			Canadian citizen	Yes	No
Landed immigrant	Yes	No			Landed immigrant	Yes	No
Non-Canadian		Yes	No			Non-Canadian		Yes	No

ISBN number: 
Retail sale price (C$): 

3. Technical Information

Electronic format of  publication  (e.g. ASCII, HTML, LIT, PDF, RB, Word, etc.): 

Software and version used to create publication (e.g. E-ditor 2, WordPerfect 5.1): 

Software and version required to read / hear the publication (e.g. Adobe Acrobat Reader 4.0, RealPlayer 7): 

Hardware required (e.g. handheld device RCA REB 1100, Pocket PC): 

4.  Access

In the National Library’s Electronic Collection, how accessible do you want your publication to be?
•	a)  Accessible to anyone who has an Internet connection  (public access) 

or
•	b)  Accessible only to clients in the National Library building in Ottawa  (restricted access)

URL of the publication on the publisher’s Website (e.g. http://www.publisher.com/title/index.html)

5.  Comments