Form

Anything with a red asterisk is required.

School or University:*

First Name:*

Last Name:*

Email Address*

Primary Phone:*

This is my:*

Office Home Cell

Secondary Phone:

This is my:

Office Home Cell

Office Address:*

My Packet:*

Is on file with you Is here and ready to be picked up Will be dropped at Gnomon I will upload here (pdf preferred) See Notes

Optional Packet Upload:

Additional Notes:

Name:

Telephone:

Email:

Please contact first with any questions:*

Professor/Teacher Assistant

Is this packet a:*

Brand New Packet Exact Reprint of Previous Packet See Notes

Course Name:*

Course Number:*

Semester*

Aproximate number of Students:*

Is this packet:*

Required for Students to Purchase Optional For Students to Purchase Pre-Order Only (We produce to order only)

I would like the student cost for the packet:*

Emailed to Me Phoned to Me I do not need an estimate

Due on Shelf/Online:

- Month - Day Year

at

/ Hour Minutes

Time:*

ASAP will be translated to mean next in line. Please let us know an accurate date so we can ensure we meet your needs. We generally ask for two weeks to turnaround new packets, and three days to turnaround reprints. Sometimes we can expedite this, so please feel free to ask.

Pull From Shelf/Online:

- Month - Day Year

at

/ Hour Minutes

Generally this is between 30 days and 1 year. Please keep in mind, permissions we order must be re-ordered

Additional Notes:

Check all that apply:*

Paper Copies Copy to Be Uploaded to Internet Copy to be uploaded to Intranet Copy to be uploaded to Extranet

I would like my complimentary copy:*

Delivered to my office Left at the store for me to pick up I would like to waive my free copy Shipped to the address in the notes section

Copies should be:*

Single-Sided Double-Sided (Back to Back) Mixed (Double and Single Sided) Burned to Disc For Upload Emailed To Me As Is See Notes

Paper Selection:*

Standard Stock 3-Hole Punched Data Copy Only Other (See Special Instructions)

Binding Options:*

Rubberband Staple GBC Comb Binding EZ Coil Sprial Binding Data Copy Only

Color of Cover Page:*

Additional Notes or Instructions:

Gnomon respects any and all copyright and intellectual property laws and guidelines issued by the United States Copyright Office (copyright.gov). We work in conjunction with the Copyright Clearance Center (copyright.com) and any and all publishers and publishing clearing houses. By clicking submit below, The person placing the order (customer) is the owner/rightsholder of the copyright(s) for the material(s) being reproduced or the customer has permission from the copyright owner(s) to produce copies of such material. As Such, customer represents and warrants that customer has the legal right to permit Gnomon to reproduce the materials, and customer hereby unconditionally grants such permission to Gnomon. Additionally customer agrees to indemnify Gnomon and Gnomon’s officers, agents, owners, employees and assigns from and against any and all claims, demands, liabilities, and related costs and expenses (including legal fees and expenses) in connection with any copyright infringement or other claim based on reproduction of the materials requested by customer. Gnomon can obtain permission for you, however, this may incur additional time and/or labor fees. Please contact us with any questions you may have.

Select 1:*

Additional Copyright and Intellectual Property Notes:

Professor/Teacher Contact Info (Required)

Assistant Contact Info (Not Required)

General Packet Information (Required)

Packet Details (Required)

Intellectual Property Disclaimer (Required)