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