Long’s-Roullet Bookbinders - Order Form for Thesis/Dissertation Printing & Binding

Date Sent: _____/_____/_____

Date Received (we complete): _____/_____/_____

Your Name: ______

Phone Number/s: ______

E-mail address: ______

Name on Thesis if Not Your Own: ______

COVER MATERIAL
Add $5 for A4 paper and/or over 2” thick
Do Copies Contain Foldouts? YES NO / QUANTITY
DESIRED / COVER COLOR
(please see www.longs-roullet.com/digitalswatch.htm) / IMPRINT COLOR
(Gold, Silver,
White, Black)
BUCKRAM
o Spine imprint - $22.50;
o Front + spine imprint - $27.50
LINEN
o Spine imprint - $22.50;
o Front + spine imprint - $27.50
BONDED LEATHER (must be hand imprint)
o Spine imprint only - $40 – Name, Degree, Year
o Front + spine imprint – $55 min. – based on title length
GENUINE LEATHER (must be hand imprint)
o Spine imprint only - $80 – Name, Degree, Year
o Front + spine imprint – $95 min. – based on title length

IMPRINTING: Spine: o Our Standard (Title, Name, Year of Degree) o Custom (please specify info, sketch on

back, or include your school’s specifications)

Front: o Our Standard (Title, Name) o Custom (please specify info or sketch on

back, or include your school’s specifications)

SHIPPING: Address 1 Receives ______Copies / Address 2 Receives ______Copies
NAME / NAME
BUSINESS/SCHOOL IF NON-RESIDENTIAL / BUSINESS/SCHOOL IF NON-RESIDENTIAL
STREET ADDRESS 1 / STREET ADDRESS 1
STREET ADDRESS 2 / STREET ADDRESS 2
CITY, STATE ZIP / CITY, STATE ZIP
SHIP VIA
UPS GROUND UPS 3-DAY UPS 2-DAY UPS NEXT DAY ______/ SHIP VIA
UPS GROUND UPS 3-DAY UPS 2-DAY UPS NEXT DAY ______

*** If additional shipping addresses are needed, please use back or attach a separate sheet. ***

PAYMENT:

o Charge my Visa/Mastercard: ______-______-______-______Expires: ______/______

Name on card: ______3-digit “V” code (from back): ______

Street number of billing address: ______Zip Code of billing address: ______

o Call me for my credit card information (we cannot start print & bind orders without credit card information).

060911 update