| First Name: |
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| Last Name: |
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| Address Street : |
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| Shipping Address: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Country: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| Please answer the following questions. |
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| Have you written your book? |
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| If so, is your book edited? |
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| If so, is your book formatted? |
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| How many pages are in your book? |
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| What size do you want your book to be? 6"x9", 8.5"x11" etc |
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Are you including pictures/graphics? Do you
have them placed in your
manuscript? |
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| How many copies will you need?: |
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| What is your target date for publication? |
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| Do you have a marketing plan?: |
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