Book Request Form

Contact Information

*Indicates a field is required

Preferred Phone: 

Board Books:

Picture Books:

Early Chapter/Advanced Picture:

Upper Chapter Books:

Middle School Books Requested:

High School Books Requested:

Adult Books:

Religious Books:

Activity Books:

Free Bookmarks for Students:

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.)*

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 dd/mm/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?*