FORM 1B Date_______________

Name___________________ Dept.___________________ Course #________________

Fill out as completely as possible for each item you have determined needs permission before being copied for class use, then return to bookstore with signed form 1A. Use as many copies of this form as necessary.

Book/Journal title___________________________________ Vol./Ed._______________

Author/Editor__________________________________ ISBN/ISSN________________

Chapter/Article title_______________________ From page______ to _______

Publisher___________________________________ Copyright Year______________

Comments:

________________________________________________________________________

________________________________________________________________________

Book/Journal title___________________________________ Vol./Ed._______________

Author/Editor__________________________________ ISBN/ISSN________________

Chapter/Article title_______________________ From page______ to _______

Publisher___________________________________ Copyright Year______________

Comments:

________________________________________________________________________

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