Request Form
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

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:
Street address:
E-mail address:
Daytime phone:
Shipping address if different than above
Street address:
Tell us a little about your book
Number of books to be printed:
Book dimensions:
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:
Sample request
I'm interested in seeing a typical bound sample book.
No sample, thank you.
Please contact me via e-mail
I would prefer that you give me a call at the number listed above

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