Fillable DESK COPY REQUEST FORM For Adopted Textbooks Only (Eastern Illinois University)

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DESK COPY REQUEST FORM For Adopted Textbooks Only (Eastern Illinois University)

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DESK COPY REQUEST FORM
For Adopted Textbooks Only
(Please type or print)
The Textbook Rental Service does not issue texts for instructional purposes. Publishers are
pleased to provide desk copies of any adopted texts, plus requested available supplements such
as instructor’s manuals, solutions manuals, and test banks, when sufficient quantities of texts are
ordered directly from the publisher. Review, complimentary, or on approval copies, must be
requested on departmental letterhead.
Please send this desk copy request directly to the publisher, or its local representative, along with
the letterhead request, if necessary. Please obtain publisher information from the “Instructional
Resources for Faculty” pamphlet compliments of the Textbook Rental Service. This material is
sent to each department and is available through your Department Chairperson and/or
Departmental Secretary. If publishers are not listed, or additional information is needed, please
contact the Textbook Rental Service at 581-3626.
TO: (Publisher Information)
Publisher: ____________________________________________________________
Address: ____________________________________________________________
____________________________________________________________
TEXTBOOK INFORMATION:
Author: ____________________________________________________________
Title/Edition: ____________________________________________________________
ISBN: ____________________________________________________________
Text Adopted As: Required Text _____________ Recommended Text _______________
COURSE INFORMATION:
Adopted Course: ____________________________________________________________
Course Title: ____________________________________________________________
Semester Requested: ____________________________________________________________
Start Date: ____________________________________________________________
Estimated Enrollment: ______________________________________________________
INSTRUCTOR INFORMATION:
Name: __________________________________ Title: ______________________________
School: _________________________________ Department: ________________________
Address: _____________________________________________________________________
_____________________________________________________________________
Office Telephone Number: __________________ E-Mail: ____________________________
Office Hours: _________________________________________________________________
Please send the following supplements: (Please be specific.)
______________________________________________________________________________
______________________________________________________________________________
I have not previously received a desk or complimentary copy of this textbook.
___________________________________________________ ________________________
Signature of Instructor Date of Request
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DESK COPY REQUEST FORM For Adopted Textbooks Only (Eastern Illinois University)

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Completed 20 August 2020

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