Employee Literature Request
Employee Name
*
Employee Email
*
example@example.com
Spouse's Name
Other adult(s) in household
Other adult(s) in household
Account Number
Date
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Quarter
*
Spring
Summer
Fall
Winter
Name and Age of Children
(Sorry, no grandchildren this go round)
Child #1
Name
Age
Child #2
Name
Age
Child #3
Name
Age
Child #4
Name
Age
Literature Requested
(Please select quantity requested)
Adults
Adult Study Guide
1
2
3
4
Other
Adult Study Guide Large Print
1
2
3
4
Daily Devotionals
1
2
3
4
High School
High School Student
1
2
3
4
High School Teacher
1
High School Journal
1
Young Teen
Young Teen Student
1
2
3
4
Young Teen Teacher
1
Young Teen Visual
1
5th and 6th Grade
5th & 6th Grade Student
1
2
3
4
5th & 6th Grade Teacher
1
5th & 6th Grade Visual
1
3rd & 4th Grade
3rd & 4th Grade Student
1
2
3
4
3rd & 4th Grade Teacher
1
3rd & 4th Grade Visual
1
1st & 2nd Grade
1st & 2nd Grade Student
1
2
3
4
1st & 2nd Grade Teacher
1
1st & 2nd Grade Visual
1
Pre-K/Kindergarten
Pre-K/Kindergarten Student
1
2
3
4
Pre-K/Kindergarten Teacher
1
Pre-K/Kindergarten Visual
1
Preschool
Preschool Student
1
2
3
4
Preschool Teacher
1
Preschool Visual
1
BTC - Adult & Teen
BTC Adult
1
2
3
4
BTC Teen
1
2
3
4
BTC Sponsor's Guide
1
Preview PDF
Submit
Should be Empty: