ESL/ELT Exam Copy Request Form

You must fill out the following form completely in order to have your request considered. Requests that do not include complete information may be denied.

We reserve the right to limit the quantity of books requested and sent. Please allow 2 to 4 weeks for delivery within the U.S. and 4 to 6 weeks for international delivery. International customers should be aware that their requests may be forwarded to the UMP representative/distributor in their country.

To request an exam copy of a non-ESL/ELT title, please see the Exam Copy Request page.

Requestor's Information

Last Name:

First Name:

Ship-to address:

• MUST include street address for delivery—do not enter P.O. Box number
• Business/academic address MUST include university and department name

Home Business

Address 1:

Address 2:

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Email Address:
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Daytime Telephone Number:
Provide the telephone number of the ship-to address above.

Instructor's Information

School:

Institution Type: Select One Community College University/College Adult Education Middle/High School Language School

Department:

Last Name:

First Name:

Email Address:

Book 1

Book Requested:

ISBN (no dashes):

Current Text:

Course Title:

Level of Students: Select One Graduate Advanced Intermediate/High-Intermediate High-Beginning/Low-Intermediate

Course Start Date: Select One January February March April May June July August September October November December Select One 2012 2013 2014 2015 2016 2017

Adoption Decision Date:

Course Enrollment for this Term:

Link to Syllabus:

Book 2

Book Requested:

ISBN (no dashes):

Current Text:

Course Title:

Level of Students: Select One Graduate Advanced Intermediate/High-Intermediate High-Beginning/Low-Intermediate

Course Start Date: Select One January February March April May June July August September October November December Select One 2012 2013 2014 2015 2016 2017

Adoption Decision Date:

Course Enrollment for this Term:

Link to Syllabus:

Further Information

If you are interested in our materials but would like more information on the books listed above, please type your questions or comments here:

Reference Code:

Please review the information you have entered to make sure it is correct. When you are finished, click "Submit Request" to send us your exam copy request.

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