CSUS Library Media Center
Media Purchase Request Form

  • CSUS faculty and staff may use this form to request for media purchase.
  • If you need to order more than one media item, please click "Add More Item" Button at the bottom.
  • Please provide detail information as requested for us to process your order correctly.

The fields with * must be filled.
Instructor's Information
* First Name:
* Last Name:
* Department:
* Email:
* Work Phone:
Home Phone:
Media Item to Be Purchased
* Media Title:
Author/Director:
Publisher:
Format:
Series/Volume:
Year of Publication:
Price:
Need Date:
Source/URL:
Note:


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