UCSB Bookstore Textbook Department Custom Publishing Course Packet Order Form

Course Information
Course Title:	Doc Ref:	Quarter:	Due Date:	Course#:	#Enrolled:	#Desk Copies
Reader Title: (Exactly as you would like it to appear on the cover)
Department:
Instructor: (last, first)					Phone: (work)	Phone: (home)
Campus Address:				Email Address:
Copy Instructions
This material is:		Copyrighted material? (If yes, please complete form below or attach a bibliography			Paper:
Required	Optional	Yes	No		Plain	3 Hole Punch

Pagination:		Printing
Yes	No	Single Sided	Double sided

Cover Color:			Create a cover page?		Yes	No

Binding:	Comb	Coil	Tape Bound	Staple	Perfect

Would you like a cost estimate for Copyright fees?			Yes	No

Additional Instructions:

Information requested to obtain Copyright approvals (if course pack contains copyrighted material)

Article sequence:	Estimated cost:	Out of Print? Yes	No	ISBN/ISSN#
Publisher/Rightsholder:				Author/Editor of Book:
Book/Journal Title:				Chapter/Article Name:
Author of Article:				Pages Requested:	From	To
Year:	Volume:	Number:	Edition:	Is it an anthology? Yes	No



Article sequence:	Estimated cost:	Out of Print? Yes	No	ISBN/ISSN#
Publisher/Rightsholder:				Author/Editor of Book:
Book/Journal Title:				Chapter/Article Name:
Author of Article:				Pages Requested:	From	To
Year:	Volume:	Number:	Edition:	Is it an anthology? Yes	No




Contact: Brett Sawyer at UCSB Bookstore		Phone: 893-4159	Fax: 893-3099	Email: brett.sawyer@bookstore.ucsb.edu