Request Form

Shortrunbooks.com Division of Dilley Manufacturing Company 215 E. 3rd Street Des Moines, IA 50309 USA Phone: 515-288-7289 Toll free: 800-247-5087 Fax: 515-288-4210

Please take a moment to fill out this form. It's easy to place your order with Shortrunbooks.com

If you plan to pay by Mastercard or Visa, we can accept your credit card number directly over the phone by calling us at 800-247-5087 during daytime business hours - 8:00 AM to 5:00 PM (Central Standard Time).

Contact Information
Your name:
Organization:
Street address:
City:
State:	Click to Select Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Zip:
E-mail address:
Daytime phone:
Shipping address if different than above
Street address:
City:
State:	Click to Select Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Zip:
Tell us a little about your book
Number of books to be printed:
Book dimensions:	Click to Select 11" X 8 1/2" 9 1/2" X 6" 8 1/2" X 5 1/2"
Spine width (if known at this time):
Cover color:	Choices are black, maroon, royal blue, red, hunter green, and white or four color process. (Note: Imprinting color is gold foil.)
Cover artwork (Note: If artwork assistance is required, please fax a rough sketch or layout to 515-288-4210 or mail to us. A cost estimate will be furnished within one business day of receipt.)
Trouble-free artwork ready to print:
YES NO
Sample request
I'm interested in seeing a typical bound sample book.
No sample, thank you.
Communications
Please contact me via e-mail
I would prefer that you give me a call at the number listed above