* Required fields cannot be left blank
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* First Name:
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* Last Name:
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* E-mail:
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* Department:
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* Status:
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* Course Number:
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Title and Price
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| Title:
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| Catalog/Flyer Number:
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| Price:
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$
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Producer
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| Producer's Name:
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| Address :
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| Phone :
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| Fax :
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| Web site:
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| E-mail :
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Distributor
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| Distributor's Name:
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| Address :
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| Phone :
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| Fax :
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| Web site:
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| E-mail :
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Rationale for Purchase
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For example, is the item for classroom instruction
or for course reserves
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Special Instructions
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Will the item be placed on
course reserve or put into a
special location
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Is this a
(select all that apply)
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Replacement
Rush Order
Other
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Video Topic
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Select a topic area that best describes the DVD or videotape
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