Request Evaluation Copy

Book Information
What Book are you Interested In?*
Has this book already been adopted?*
- Yes
- No
Notes
Course Information
Course Name and Number
When is the Course Offered?
Anticipated Enrollment
Book Title used previously for this Course?
School Adoption Deadline
Personal Information
Name*
First Last
Email Address*
Phone Number
School Name*
Department*
Job Title*
Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country