LADPAC Copyright Only Order Form

(fields marked with * are required)
University/School:*
Professor's Name:*
Professor's Home Phone:Professor's Work Phone:
Professor's E-mail:*
Add'l Contact's Name:Contact's Phone:
Course Title:*
Course Number:
Date Due in Bookstore: (MM/DD/YYYY)Expected Enrollment:*
First Day of Class:* (MM/DD/YYYY)PO#:

Term:

Semester/Quarter:*
Year:*                  

Yes, this custom LADPAC has been produced by LAD before
Yes, there are changes to this custom LADPAC
Special Instructions:

We have granted permission to LAD Custom Publishing to produce the above outlined custom LADPAC. This custom LADPAC is REQUIRED for the students enrolled in this course and is intended for educational purposes only. We certify that all copyright information listed is complete and accurate. We understand that any incomplete information may cause delay in the production and delivery of this LADPAC. This LADPAC is renewable and constitutes an exclusive order for the production of this material, and we agree not to give or grant any other company permission to publish or distribute the materials unless the professor/bookstore notifies LAD Custom Publishing in writing 30 days prior to the start of the academic term. We further defend and indemnify LAD Custom Publishing against any liability concerning the accuracy of the information provided on this order.
* I Agree I Disagree