CSUS Library Media Center
Media Purchase Request Form

  • CSUS faculty and staff may use this form to request for media purchase.
  • 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 - Item 1
*Media Title:
Author/Director:
Publisher:
Format:
Series/Volume:
Year of Publication:
Price:
Need Date:
Source/URL:
Note:
Media Item to Be Purchased - Item 2
Media Title:
Author/Director:
Publisher:
Format:
Series/Volume:
Year of Publication:
Price:
Need Date:
Source/URL:
Note:
Media Item to Be Purchased - Item 3
Media Title:
Author/Director:
Publisher:
Format:
Series/Volume:
Year of Publication:
Price:
Need Date:
Source/URL:
Note:


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