Examination Copy Request Form

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All paperbacks are available on 90 day approval to teachers wishing to evaluate them for course use.  Copies are invoiced on 90 day approval. The invoice is canceled if you return the book or provide proof of adoption within 90 days OR you may keep the book for personal use by paying the invoice.

ALL fields with asterisks must be completed for your request to be considered. Thank you

I. Title Requested

*Title:
*Author(s):
*ISBN:

II. Course Information

*School/Institution:
*Department:
*Course Number:
*Course Title:
*Start Date:	(e.g. Fall 2005)
*Course enrollment:

*Text currently in use for this course:
Title	Author

III. Mailing Information

*Instructor's Name:
(unfortunately we cannot mail to your home address)
*Department:
*School/Institution:
*Address 1:
Address 2:
*City:
*State:
*ZIP:
*Phone:	(please include area code)
*Email:
Additional Comments: