Audio Transcription Order Form for Leisure, Vocational and Personal Materials

Use this form if you are requesting audio transcription of print material that is for your individual use. Use a separate form for each book or set of materials. If you have any questions, please call us at 651-539-1422, 1-800-652-9000 or TTY 1-888-665-3276 and ask for the library technician.

This form consists of 5 parts: (1) audio type; (2) book information; (3) customer information; (4) transcription instructions; and (5) signature. Be sure to complete all sections.

Mail to Audio Services, Communication Center, State Services for the Blind, 2200 University Avenue West #240, Saint Paul MN 55114-1840:

Audio Type

Include Braille Labels?

Date Transcription Needed

Book Information

Customer Information

Qualifying Print Impairment

Customer Agreement and Copyright Notice
.

Permanent address, if different than above

Transcribing Instructions

Indices will not be transcribed. Pictures and maps will be identified and captions read; they will not be described. Provide specific transcribing instructions as indicated below. Note any other instructions in the "Special Instructions" area.

Page Numbers

Transcribe Checked Items

on pages

Table of Contents

Other - Specify

Tables, Charts, Graphs, Diagrams, Figures

Footnotes

Signature