Desk Copy Request Form

Thank you for adopting a SIAM text for your upcoming course. If you have any questions, contact us at textbooks@siam.org.

Please be sure to provide a complete address so that we can ship the title you have requested without delay.

Bolded fields are required.

Please note: Before shipping your desk copy, SIAM must verify that the text is being used in an upcoming course. To do so, we request that you either a) include a link to your online syllabus showing the text as a required text, b) fax us your syllabus showing the text as a required text (fax number is +1-215-386-7999, Attn: Textbook Editor), or c) fax us a copy of your bookstore’s order confirmation for the adopted text (fax number is +1-215-386-7999, Attn: Textbook Editor). After we receive this verification, we will process your order.

Name:

University:

Shipping Address:

Telephone Number:

E-mail Address:

Book Title:

Book Author:

Book Order Code (i.e. OT44) :
The order code can be found by searching our online catalog at www.siam.org/catalog/.

Book ISBN:

Course Name and Number:

Professor's Name:

Semester/Year Offered:

Expected Enrollment:

Link to Online Syllabus (if available) for SIAM verification:

If you would like your text express shipped to you, we ask that you pay the shipping fee. Please provide your credit card information in the space below, and select the type of shipping you would like. We will charge your credit card and ship your book via the method you selected. We accept Visa, MasterCard, and American Express.

USA Canada Outside US/Canada

2nd/3rd Day ($10.99) 2nd/3rd Day ($13.98) Express 3/6 days ($32.98)

Next Day ($13.98)

Name on Credit Card:

Credit Card Number:

Expiration Date:

CVV2:
CVV2 is the three digit number printed in reverse italic characters on the signature panel of all Visa and MasterCard cards following the last four digits of the account number.

Billing Address (if different from Shipping Address above):

Comments:

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