Book Request Form

Contact Information

*Indicates a field is required
First Name*
Last Name*
Email*
Organization/School Name*
Title
Phone*
Preferred Phone: –None–HomeWorkMobileOther

Address Information

Street*
City*
State/Province*
Zip Code*
Country*

Books Information

Please provide the number of books for each category
Board Books (Birth – Pre-K):
Picture Books (Pre-K – 2nd Grade):
Early Chapter/Advanced Picture (2nd Grade – 4th Grade):
Upper Chapter Books (4th Grade – 5th Grade):
Middle School Books Requested (6th Grade – 8th Grade):
High School Books Requested (9th Grade – 12th Grade):
Adult Books (18 and Up):
Religious Books:
Activity Books:
Free Bookmarks for Students:

Other Book Distribution Information

Anything else we should know about the books you are requesting?
How many children do you plan to serve with these books?* (Please enter numbers only, no text or number ranges)
What specifically will these books be used for? (Hold down the Ctrl button to select more than one option.)*

Building Home LibrariesClassroom LibrariesBook GiveawayLiteracy or Curriculum Night/FairSummer Reading/Summer SlideOther
How many books do you plan to provide per child?* (Please enter numbers only, no text or number ranges)
What date would you like to pick up your books? Pick-up days are Monday-Thursday. (Please enter a date in the format mm/dd/yyyy)*
What time would you prefer to pick up your books on the date you selected? Pick up times are between 10am-4pm.*
When is your expected book distribution date?*
Would you like to self-select your books or have them pre-boxed by Promising Pages staff?* –None–Self-SelectPre-Boxed