CUSTOMIZED TEXTBOOK ORDER FORMWORKSHEET by parpar

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									  CUSTOMIZED TEXTBOOK ORDER FORM/WORKSHEET
  Information for your customized textbook’s title page—                             CT # _______________    NEW        REPRINT
  EXACTLY AS IT SHOULD APPEAR ON THE TEXT:                                           Customer # ___________________________________________________

  Your course Number/Name_____________________________________                               _____________________ Fax # (
                                                                                     Phone # (      )                           )
                                                                                                                         __________________________

  ___________________________________________________________                        Ship to: ______________________________________________________

  Term/Year _________________________________________________                        _____________________________________________________________

  School Name _______________________________________________                        _____________________________________________________________

  ___________________________________________________________                        Contact: _____________________________________________________

  Department Name ____________________________________________                       Bill to: _______________________________________________________

  ___________________________________________________________                        _____________________________________________________________

  Instructor/Professor Name _____________________________________                    _____________________________________________________________

  ___________________________________________________________                        Bookstore Contact: _____________________________________________

                                                                                     P.O. # :_______________________________________________________


                                                                                                                                       OFFICE USE:
    #
                       TEXTBOOK TITLE                                                         CHAPTER TITLE                            TEXTBOOK #
                                                                                                                                        CHAPTER#

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DATE R EQUIRED :                /        /

Quantity Ordered: ______________________ Instructor Copy(ies): _______________________
                                                                                                                       Information from Your
Internal EI Copy(ies): ______________________                                                                          Account Representative

I verify that the information concerning title page, quantity, date required, text and chapter, and           Item Number: ________________________
sequencing is correct.
                                                                                                              Price Per Text: ________________________
________________________________________________________ ___________________
Instructor Signature                                                                  Date

								
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