Requesting a Desk Copy or Review Copy Order Form

Requesting a Desk Copy or Review Copy Order Form

In order to submit this form, you must be an instructor, director or the concerned person of the institution responsible for ordering books and supplies.
Your Name

First NameLast Name
Your E-mail
Your Phone Number

Phone NumberEnter Extension or 000
Institutions Director or Program Co-ordinator Name

First NameLast Name
Institutions Director or Program Co-ordinator E-mail
Who makes the final decision for adopting a New Title?

First NameLast Name
Which best describes your account?
Institution Name
School, College, Univesity, Trade School, Private Career, Vocational School
Institution Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Main Contact Phone Number

Phone NumberExt
Main Contact Fax Number

Area CodePhone Number
Institutions Education Delivery Mode
Institutions Website
Chair person’s name, phone number, and e-mail address (for verification of the instructor’s faculty status)
Book Title
Name of the textbook you are requesting.
Book ISBN
ISBN number of the textbook you are requesting.
Anticipated Class Size
We are requesting the book
Anticipated Decision Date (for adopting the title)

MonthDayYear
Anticipated Class or Semester Start Date

MonthDayYear
I agree to the above "terms of review or desk copies". Your Initials or Signature
Date of submitting the request

MonthDayYear
Desk Copy Deposit
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Desk Copy or Review Copy Deposit$30.00
This is only a deposit and will be refunded when the book is received back. However, if the book is adopted, and an order is placed, this desk copy will be considered an instructors free copy, and the $30 will be refunded back.

Total $0.00
Your Message or Comments (optional)
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Requesting a Desk Copy or Review Copy Order Form

Desk Copy Deposit*

Desk Copy Deposit