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					                                                                                                                                   Order No: ________________
                                     City University of Hong Kong Press — Coursepack Production Centre
                                                                                                                                 Date Rec’d: ________________

           Coursepack Order Form (by credit card for Semester B, 2011–12)

 Course Code
 Unit Price              HK$                     .00                                Copies Required                                    (copy/copies)

                                                                              Total Amount (HK$)
 Name                                                                               Staff/Student No.
 E-mail                                                                  @                                              (please fill in the email clearly)

 Mobile                                                        Signature
                                                                               (If you send a soft copy of the form via e-mail, no signature is required.)


                                                 Payment by Credit Card
       Master Card*                    or                VISA Card*                  (* Please marked with “x” to select the appropriate card.)

Card-holder’s Name:
                                       ( in BLOCK   LETTERS)

Card Number:
Card Validation Number
(This is the 3-digit number on the
signature panel at the back of the
                                                                     Expiry Date:                                     —
credit card.)
                                                                                                      Month                             Year

Total: Amount               HK$
Signature of
       (Note: The amount will be charged to the above credit card account. If you send a soft copy of the form via e-mail, no signature is required.)


       Pick-up:           Within the following period, you can pick up your coursepack 5 working days
                          after placing your order. Cut-off time every working day: 4:00 pm

        For Students: Period:                  6 January 2012 – 20 January 2012 (Monday to Friday only)
                                               (No service on Saturdays, Sundays and Public Holidays)
                               Time:     6:00 to 7:00 pm
                               Location: Temporary Counter (next to Law Section) in the Library
        For Staff:             Please indicate department and room number for internal delivery.

                                            How to send the Order Form to us
  1. If you use the printed Order Form, please return the Form to us by one of the following methods:
     a. Send the Order Form by Fax to 2628 2606
          (A FAX machine is available at the Students’ Union counter near the swimming pool); OR
     b. Drop the Form in the Collection Box at the Information Counter at the entrance of the Library; OR
     c. Pass the completed Order Form(s) to us when the Temporary Counter is in operation in the Library.
  2. If you use the electronic Order Form (in Microsoft Word format) downloaded from our web site: Please complete the Order Form and
     e-mail it as an attachment to
Remarks: CPPC centre will send you an email for confirmation (within one day) after you placed the order.
                                     Enquiry: 3442 6393                        Fax:      2628 2606

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