Sample Request Form

Request for Samples

Richard C. Owen Publishers, Inc. is happy to send
you up to three sample books from any of our 5 product lines of children's books. We do this to give
you an opportunity to see the quality of our books.

Richard C. Owen Publishers, Inc., reserves the right to limit the number of requests for free sample to three books per individual. We reserve the right to suspend. this offer at anytime without prior announcement, and to reject any request deemed to be inappropriate.

All books must be shipped to a school street address within the continental United
States Of America.

Click logo to see the product lines

Grades K-2	Grades 2-4	Grades 2-5
Grades 2-8	Grades 3-7	Working Together

Please send the following book(s) free of charge. I understand that these
are sent to help me decide if I will purchase multiple-copy packs or multiple-title
collections for instructional purpose with children in my class. I further understand
that I must complete all questions in SECTION A to be eligible to receive the sample
book(s) I have requested. I will include any information I can in SECTION B and C.

SECTION A
How did you hear about the FREE SAMPLES?*      Click down arrow and click on a choice

Request Date*

         To see the available titles to select from in a product line, click on any product line listed below.

                              Books For Young Learners    School Journals    Tri-star     The News
Click on the down
arrow for each         Click on the Product                                    Click on the Grade level                                    Type in the book title
box for options.          of your choice for each sample                  for your choice for each sample                       of your choice for each sample
  Sample 1           Title
  Sample 2           Title
  Sample 3           Title

  Name                   E-Mail
Position               For what grade(s)
School Name              Grades in the school
School Street Address              District
City           State          ZIP
  Sch Telephone    Sch FAX          Reading Recovery (Y,N)     Title1 (Y,N)

Do you receive the Richard C. Owen Publishers, Inc., catalog?   (Y,N)
Is your school or district involved with The Learning Network®? (Y,N)
Do you currently use our books for instruction? Books for Young Learners (Y,N) Tristars (Y,N)
                                                                          School Journals (Y,N)                 The News (Y,N)
Does your school have a instructional resource room (a central repository for books)? (Y,N)
If yes, what leveling system is in use in the instructional resource room or classroom?
What other materials are you currently using for instruction?
        Basal (Y,N)    Little Books (Y,N)    Other (Y,N)
What is the dollar amount of instructional materials purchases for language arts that you will make
        this year?
-----------------------------------------------------------------------------------------------------------------------------------
SECTION B

If you know-- What is the dollar amount of instructional materials purchases for language arts that the school
      will make this year? $ Is this a budgeted line item? (Y,N)   or a one-time grant? (Y,N)
Does your school make decisions as a faculty regarding purchases of instructional resources in literacy? (Y,N)
When does your school make purchases for instructional resources?
Please provide-- Who should we contact regarding those purchases?
       If someone other than yourself please complete the "Other Contact" section below.

SECTION C

Other Contact (optional)
Name          E-Mail
Position          for what grade(s)
School          Grades in the school
School Street Address          District
City          State     ZIP
  School Telephone                                    School FAX
How did you hear about our samples?

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