New England Historic Genealogical Society

Research Services Order Form



Research Information
*Reminder: You must be logged in as a NEHGS member to receive your member discount.

*Required field.

Please state the number of hours you wish to authorize for research * (Maximum of 5 hours):
  



*Name of individual being researched:
  

*Please provide all pertinent information you have concerning this individual. For example: names of spouse(s), names of children, names of parents, dates and locations of birth, marriage, death; location(s); date of immigration; etc:
  

*Please state the specific question you wish answered or your general research request:
  

*Please cite the sources you have already searched (to prevent duplication of efforts):
  

Additional Comments:
  
  Contact Information
Member Number:
  
Title:
  
*First Name:
  
Middle Initial/Name:
  
*Last Name:
  
*Mailing address:
  
*City:
  
*State/Province:
  
*Zip/Postal Code:
  
*Country:
  
*Email Address:
  
*Telephone(inc. area/intl code):
  


Billing Information
*Method of Payment:
  
*Name exactly as it appears on credit card:
  
*Billing Address:
  
*City:
  
*State/Province:
  
*Zip/Postal Code:
  
*Country:
  
*Card Number:
  
*Expiration Date (mm/yy):
  
*Card Security Code: