Fillable Module Request Regular Module Request

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Module Request Regular Module Request

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MODULE request
(see semester deadlines)
Print Shop - Central Services - Los Medanos College
REQUESTER
NAME OF READER / WORKBOOK
TODAY’S DATE DUE DATE/SEM. DEPARTMENT EXT. / CONTACT
STUDENT QTY. # of ORIGINALS
+ INSTR. COPIES
B.S. AJSTD. QTY.
DEAN OR SUPERVISOR APPROVAL
sign:_________________________
PRINT STYLE & BINDERY
NO HOLES NEEDED
NEW MODULE
STAPLES (1 or 2)______
(must use brads if over 100 sheets)
COLLATE ONLY
(I will provide alternative binding)
COVER (paper/color)_____________
SINGLE SIDED (no back sides)
BRAD FASTENING ONLY
3-HOLE PUNCH
REVISED (delete last le)
DO NOT RE-USE COPIES
FROM PRIOR VERSION/S
NO CHANGES (use previous le)
COLOR PAPER INSERTS (pre-press)
(1 to 2 colors only, up to 10 insert areas)
_____________________________
_____________________________
print on inserts
leave blank
_____________________________
PLAIN PAPER (all interior pages)
AUTO PAGE NUMBER
(alignment, starting at pg.#, etc.)
____________________________
OTHER MODULE SPECIFICS
PRINT SHOP STAFF USE ONLY
B#:_______________________
saved to:____________#p_____
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
binding nished by: _____________
nal box disposition by: ___________
BILLING:
SPECIAL NOTES/REQUESTS
NOTE: Please ll out a seperate request
for each master original/le submitted,
and each semester needed. Copyrighted
materials will not be printed without
release from the publisher or author.
CHAPTERIZE CONTENTS
(start new subject on front-right pgs.)
RE-MASTER ORIGINALS
(combine les, enhance quality, etc.)
____________________________
RUN ORIGINAL “AS IS”
(the le is completely print-ready)
PRE-PRESS OPTIONS
P R I NT SH OP STA F F US E O NLY
qty in this box:_______ box#____of____ + disp. by:_______ nal qty:________
MODULE request
(see semester deadlines)
Print Shop - Central Services - Los Medanos College
REQUESTER
NAME OF READER / WORKBOOK
TODAY’S DATE DUE DATE/SEM. DEPARTMENT EXT. / CONTACT
STUDENT QTY. # of ORIGINALS
+ INSTR. COPIES
B.S. AJSTD. QTY.
DEAN OR SUPERVISOR APPROVAL
sign:_________________________
PRINT STYLE & BINDERY
NO HOLES NEEDED
NEW MODULE
STAPLES (1 or 2)______
(must use brads if over 100 sheets)
COLLATE ONLY
(I will provide alternative binding)
COVER (paper/color)_____________
SINGLE SIDED (no back sides)
BRAD FASTENING ONLY
3-HOLE PUNCH
REVISED (delete last le)
DO NOT RE-USE COPIES
FROM PRIOR VERSION/S
NO CHANGES (use previous le)
COLOR PAPER INSERTS (pre-press)
(1 to 2 colors only, up to 10 insert areas)
_____________________________
_____________________________
print on inserts
leave blank
_____________________________
PLAIN PAPER (all interior pages)
AUTO PAGE NUMBER
(alignment, starting at pg.#, etc.)
____________________________
OTHER MODULE SPECIFICS
PRINT SHOP STAFF USE ONLY
B#:_______________________
saved to:____________#p_____
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
by/qty/date:__________________
binding nished by: _____________
nal box disposition by: ___________
BILLING:
SPECIAL NOTES/REQUESTS
NOTE: Please ll out a seperate request
for each master original/le submitted,
and each semester needed. Copyrighted
materials will not be printed without
release from the publisher or author.
CHAPTERIZE CONTENTS
(start new subject on front-right pgs.)
RE-MASTER ORIGINALS
(combine les, enhance quality, etc.)
____________________________
RUN ORIGINAL “AS IS”
(the le is completely print-ready)
PRE-PRESS OPTIONS
P R I NT SH OP STA F F US E O NLY
qty in this box:_______ box#____of____ + disp. by:_______ nal qty:________
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Module Request Regular Module Request

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Completed 17 February 2020

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