HIGH SCHOOL BOOK ORDER FORM

Please Print

Social Security Number _____/_____/_____ (Social Security Number requested 
                                         for recordkeeping purposes only.)

Name _____________________________________________  Date ___________________

Address	____________________________________________________________________

City/State/Zip _____________________________________________________________

Home Phone ___________  Day Phone ___________  E-mail _______________________

___ I prefer used books when available.  

Course Number and Title ____________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Author	     Title	       Edition         Publisher	        Price

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

                     Colorado state sales tax (3.0%) $ __________

                                     Local sales tax $ __________

                                            Handling $ __________

                                               TOTAL $ __________
                                                       (No state tax assessed nonresidents.)

DO NOT SEND CASH

___ Check or money order  ___ VISA  ___ MasterCard  
___ American Express**  ___ Discover*

____________________________________________________________________________
Account Number

____________________________________________________________________________
Expiration Date

____________________________________________________________________________
Cardholder's Signature



*  At Adams State, Colorado State, CU-Boulder, CU-Colorado Springs, & CSU-Pueblo
** At Colorado State, CU-Boulder, & CU-Colorado Springs

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 

FOR HIGH SCHOOL AUTHORIZATION ONLY

If the Board of Education is to be billed for the cost of textbooks, the following
authorization must be signed by the school official with authority to approve such charges:

Textbooks for ____________________________________
                       (Name of Student)

In ________________________________________________
                         (Course/s)

are to be charged to School District No. ______________ and bill sent 

to _________________________________ at _____________________________ 	
      (Name of School Official)               (School Address)

Signature _________________________________________________	

SEND THIS ORDER TO: Independent Learning Book Order Desk, University Memorial Center,
University of Colorado, Campus Box 36, Boulder, CO 80309-0036.
Telephone: (303) 492-6411, Fax: (303) 492-0420. Toll Free: 1-800-255-9168.