BOOKWORM ORDER FORM

All fields in red must be filled.
All orders submitted can not be cancelled.

Please provide the following contact information:

First Name
Last Name
Middle Initial
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail
URL

Please provide the following ordering information (max. 6 items):

QTY DESCRIPTION (Title & Author) PRICE
Shipping & Handling
Total Price

Preferred method of payment:
Bank Transfer         Cheque

Enter the following information if different from contact information above:

SHIP TO:
Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Please make sure that everything is correct before submitting
An e-mail will be sent to confirm your order within 3 working days

Bookworm.

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