Custom Publishing Packet Form

Semester:	Date Needed By:	Instructor:



Course: (ex. DEA 150, NCC 506-2)	Packet Title:	Estimated Enrollment:
		# of Desk Copies Desired:


Office Phone:	Office Address:

Alternate Contact (decision-maker):	Alternate Phone:

FULL E-mail address:	Office Address:



Packet is:	Binding Options:
Number Pages ?($10.00 fee spread across enrollment)
Printing Options:(1/2 cent/page fee for single-sided)


Re-use of Old Articles:
Term of past articles:


We encourage you to review a proof copy before printing:
Do you want to be contacted if packet price is more than $75.00?
Use Reprint Process:
If you use the Reprint Process -We will underprint and then you can print on demand using the 2 business day reprint system
If you do not use the Reprint Process - We will print 100% of enrollment and you agree to pay for any leftovers


Additional desk copies, scans, bibliographical services will be paid by :
Dept. Charge #:


Special Instructions:



Packet will be brought to Custom Publishing:


To schedule a pick-up, just fill out the fields below or call us at 255-2932. We'll have someone there within 24-hours!
Office Address where pack should be picked up:
Hours office is open:
Phone #:
Special Pick-up Instructions:



Please Note: If you do not receive a confirmation email within 24 hours (or receive a timeout error) after submitting this form please email Jim Lawrence at jsl10@cornell.edu or call 255-2932 or download the pdf version of the form and fax it to: 255-0083


If you do not receive am email within the next business day please contact Jim Lawrence at jsl10@cornell.edu.