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.)