Loose-leaf pages held together in a three ring binder. Some pages have rips in their holes, so a few are loose, but none appear to be missing. A few pages have small annotations, but nothing major. Some pages are creased. May not include access codes or supplemental items. Make sure to view all pictures before purchasing. Please don’t hesitate to contact with any questions or concerns and we’ll get back to you by the next business day. 7