Course Reader Order Form
UCP SOUTH: LOS ANGELES, CA
Tel: 800-622-9313 / 213-743-4800
Fax: 213-743-4804
Email: admin_south@universitycustompublishing.com
UCP NORTH: MOUNTAIN VIEW, CA
Tel: 800-622-7303 / 650-917-1883
Fax: 650-917-2096
Email: admin_north@universitycustompublishing.com
CUSTOM PUBLISHING USE ONLY
Date: ____________ Date Needed: ___________ Term: __________
Is this material
 REQUIRED
 OPTIONAL
Your material will be made available at the University Bookstore
ISBN:
_____________________
CTRL No: _____________________
Please indicate title to be printed on cover (if any):
________________________________________________________
DISC:
_____________________
 Professor  Dr.  PhD  MD  Other ___________________
Instructor:_______________________________________________________________________________
Phone#: ________________________________ E-mail: __________________________________________
Contact Person: ___________________________________________________________________________
Phone#: ________________________________ E-mail: __________________________________________
Dept. & Course No.: ___________________________________ Section Number(s): ______________
Specific title of material: ____________________________________________________________________
(This title will appear on the cover of the Course Reader along with the course number )
Are you requesting exact material from a previous semester?
 YES
 NO
If YES, please list exact term and year: _____________________________________________
Estimated enrollment for the class: _____________________ # of instructor copies needed: _____________
 YES
Is all the material included at this time?
 NO If no, when? ____________________
 YES
Does your Course Reader contain any copyrighted material?
 NO
Your originals will be returned to the University Bookstore Textbook Department for pick up.
Production & Finishing
Printing:
 DOUBLE SIDED
 SINGLE SIDED
Binding:
 COIL
 TAPE
Special:
 INSERTS #________
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 3-HOLE
 STAPLE
PRINTED INSERTS #________
 TABS
 PAGINATE
 SHRINKWRAP
 CUSTOM COVER
Additional Instructions: _____________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
___________________________________________
Instructor/Contact
Date
___________________________________________
Custom Publishing Rep
Date
Additional Information
Date
Comments
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