JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PCIP Request
I am pleased to provide you with Publisher's Cataloging-in-Publication (PCIP) data blocks.
To make a PCIP request, please complete the following form and email a draft copy of relevant portions of the work (e.g. title page, verso, table of contents, and index) to the email address below.
I'll contact you shortly to confirm receipt.
Thank you.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Contact name
*
Your answer
Email
*
Your answer
Phone
Your answer
Preferred turnaround time
*
Regular, 10 calendar days from receipt of payment ($50)
Rush, 5 calendar days from receipt of payment ($75)
Author(s) of the publication
*
Your answer
Has this author published other titles? If so, list up to three.
Your answer
Is the publication for a juvenile audience? Age range?
Your answer
Title of the publication
*
Your answer
Does the publication include any of the following? Check all that apply:
index
bibliography/references
Is the publication part of a series? If so, please give the series title.
Your answer
City and state of publication
*
Your answer
Publisher
*
Your answer
Copyright date
Your answer
ISBN
Your answer
LCCN
Your answer
Please provide a brief summary of your publication.
This will increase accuracy of subject headings and classification numbers.
Your answer
Optional comments
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
