Textbook Review Copy Request

If you would like to use one of our publications as a textbook, and would like a review copy, please provide us with the following information

✻ = Required

Name of the publication you would like to use ✻

Publication number

Author ✻

Name of the class in which the publication will be used ✻

Is this an ADA request for a student with a disability? ✻

Yes No

If yes, stop here. Please e-mail Cynthia Kintigh at cckintigh@ucanr.edu for a request form for ADA materials.

If no, please proceed with the rest of the survey.

Term and year in which the class will be taught ✻

Anticipated enrollment in the class ✻

Name of professor teaching the class ✻

Name of college or university ✻

Contact and shipping information

Contact name ✻

Shipping address:

We prefer to ship by UPS so please no PO Boxes ✻

Contact e-mail ✻

Contact daytime phone ✻

Additional comments

Bookstore information

We'll send your bookstore information about ordering, discount, and return policies for resellers.

Name of your bookstore ✻

Bookstore contact name

Bookstore contact e-mail

Survey Verification✻

For verification that you are human, please enter the following code in the box below:
GSBVXE

(if the code is not entered correctly, the survey will not be submitted)