BOOK ORDER FORM

This form is for those wishing to order directly from Publish America, paying with a personal check or money order. If you want your copy signed, please make a request. 

Name:______________________________________________________ 

Address: ____________________________________________________ 

City: ____________________State: ________ Zip/Postal Code: ________ 

Country: _________________

#____Books @ $14.95 US each : Title: The Seagull Who Was Afraid To Fly  Isbn: 1413718906  

 ______ Shipping @ $3.00 US and .50 for each additional book

 ______ Tax @ 5% each ( Maryland residents)

Total Payment Included _______________

By Credit Card:

Credit Card Name:__________________________

Number: _________________________________

Expiration Date:______________

Signature:____________________________

You may print this form and send a check or money order made payable to:

Publish America, Inc.

P.O. Box 151

Frederick, MD 21705