Email, Print/Fax or Phone this Form (Fax and Phone number below)
Book Listing Application Form The Book Listing fee is $65.00 per title
Title of Book
Author's name(s)
Website address where this Book can be purchased
Website address where a picture of the bookcover can be downloaded
I will... Mail a check (address below) Mail a money order (address below) Pay by charge/debit card below
My Name as it appears on my charge or check debit card:
My card's billing/statement street address (city and state not necessary)
My zip code
My phone number
My email address
My card number is... My card's Expiration Date is My card's CVV code is
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