Name of person making the request: _________________________________________

Name of Professor(s) teaching the course: _____________________________________

(Please use a separate form for each course.)

Title requested: ________________________________________________________

I have not previously received a desk copy of the title(s) listed above.

The above text is: ____ required ____ recommended reading

Please send additional copies for:

Name: _________________________________________ ____ Professor ____ TA

Name: _________________________________________ ____ Professor ____ TA

Name of course(s): ____________________________________________________

Number of students: ___________

Name of purchasing bookstore: ___________________________________________

This course begins on ____ (day) ____ (month) ____ (year)

Ship book(s) to:

Name: _____________________________________________________________

Department: _________________________________________________________

School: _____________________________________________________________

Street Address: _______________________________________________________

City, State, Zip: _______________________________________________________

Phone: _____________________________________________________________

(Please note: An academic affiliation and the name of the purchasing bookstore must be provided in order to receive a desk copy.)