Please PRINT BOTH PAGES, fill them out, include your payment, and mail with one book to the address below.
Optional: You may safely fax this form if you are paying by credit or debit card. (Our fax is completely secure.) Faxing will allow your services to be placed in our first available time slot. Then, mail your book and this form. American Legacy Books You may safely fax credit/debit card payments (24 hours, 7 days per week) to: Fax: 202-243-0668 Please PRINT CLEARLY in large letters. Title of Book: ________________________________________________________________________ Author's Name: ______________________________________________________________________ Address: ____________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Telephones: Day:_________________________ Cell (Optional): ______________________________ BEST Email Address: _________________________________________________________________ Web Site Address (optional): ___________________________________________________________ Your postage and/or expenses budgets (if you choose any) are not required now. We will notify you when it is time to ship copies of your books to us. You will determine the quantity. Place a mark in the bracket(s) beside your selection(s). Submit one book (unless we have one). • PUBLICITY SERVICES
*For campaigns: Circle the plan that interests you: Plan A, Plan B, and/or Plan C. Then, fax or mail this form with no payment. We will submit the estimates to you. Alternatively, you may call 1-888-331-2665. • MARKETING SERVICES
[ ] ORDER-TAKING SERVICES with ONLINE BOOKSTORE LISTING .................. $99 set-up American Legacy Books Author’s Signature: __________________________________________________________________ METHOD OF PAYMENT [ ] I have enclosed a check from a United States bank account. [ ] I have enclosed a certified check or cashier’s check from a United States bank. (Ask your bank.) [ ] I have enclosed a money order (only U.S. Postal Service, American Express, or Western Union). [ ] I am using my American Express, Discover, MasterCard, or Visa credit/debit card. Please make your numbers large and legible. >>> Please fill in the TOTAL: $__________________
Card Number:___________________________________________ Expiration Date: ______________ Please make your letters are large and legible. Please type or print. Cardholder’s Name (exactly as on card): __________________________________________________ Cardholder's Address (required): ________________________________________________________ __________________________________________________________________________________ Telephone Number of Cardholder (also required): ___________________________________________ Required Security Code: ________ Look on the back of your card on the strip where you signed your name. There are sets of numbers on that strip. The security code is the last set of three numbers. American Express has four small numbers on the front of the card, on the right side, and above the credit card number.
Signature of Cardholder: ______________________________________________________________ |