Desk Copy Request Form

Book Requested: _________________________________ Date: ________

Name: ______________________________________________________

Title or Position: ______________________________________________

Department: __________________________________________________

College or University: ___________________________________________

Mailing Address: _______________________________________________

City: _______________________ State: __________ Zip: _____________

Phone: ____________________ Email: ____________________________

Course Name: __________________________ Course #: ______________

Estimated Enrollment: ____________ Class Starts: ___________________

Note: Books will be sent to College or University addresses only. Please make additional copies of this
form for each book requested; limit of three book requests.

Mail or Fax to:
Child Care Information Exchange
P.O. Box 3249
Redmond, WA 98073
(425) 836-8865 - fax

To order directly, contact:
Debbie Goodeve
Desk Copy Manager
phone: (425) 836-9183
email: dgoodeve@ChildCareExchange.com