Please provide us with as much information as you know on this page and submit it by clicking the send form button. Type the details seperated by commas and when you have completed the information press your TAB key to move to the next box.

Don't worry if you know very little, as it is possible to work from a minimum of a name, year and place of birth (or approximate area) in Britain or Ireland. It is suggested you ask around the family to find out what is already known.

If you wish you can print out this form and send it to us by post.

Please research the ancestry of the following surname(s)/line(s):

SURNAME(S):
Line 1
Line 2

Please enter details according to the surname(s)/line(s) you have chosen:

YOUR FULL NAME, PLACE & DATE OF BIRTH:

YOUR FATHER/MOTHER's FULL NAME, PLACE AND DATE OF BIRTH:

Surname / Line 1
Surname / Line 2

YOUR FATHER & MOTHER'S DATE & PLACE OF MARRIAGE:

YOUR GRANDPARENTS NAME, PLACE & DATE OF BIRTH:

Surname / Line 1
Surname / Line 2

ANY OTHER INFORMATION:

YOUR NAME & POSTAL ADDRESS:


Telephone No:

Email Address:

Please choose one of the following three payment options:

	I will send in the post a cheque/postal order for $195.00 (US) for the one line (surname) investigation or $365.00 (US) for two lines made payable to DISCscribe Ltd. I will forward the two remaining installments as I receive each of the separate parts of the report. I understand that I can stop or postpone the report and subsequent payments at any time.
	I will send a cheque/postal order made payable to DISCscribe Ltd. for $565.00 (US) for the one line (surname) investigation or $995.00 (US) for the two line investigation.
	I require a Personalised Investigation and will send a cheque/postal order for US$177 made payable to DISCscribe Ltd for a minimum of six hours work at US $29.50 per hour. I include my requirements, including what I already know and the sources, if any, I have researched.

AND POST PAYMENT TO CONTACT ADDRESS SHOWN BELOW

We will be pleased to provide an update while research is in progress. All information that is supplied will be treated in the strictest of confidence and only used for the benefit of research on your behalf.

Contact Address: George Butters c/o DISCscribe Ltd. 123 York Street, Unit 103 Fredericton, New Brunswick Canada E3B-3N6

Telephone:(506)455-3108 Fax:(506)455-8772 Email: research@tartans.com