Name____________________________________________________________________Date_____________________

Address___________________________________________________________________________________________

Home Phone_________________________________________Cell___________________________________________

Email_______________________________________________

Number of books ordered________$20.00 each book--Total enclosed $_______________________

                                                        ( $17.95 + $3.05 ...Tax/Packaging/Postage)

                                                         Make checks to :   Rick Anderson

                                                                                      111 Moss Wood Lane

                                                                                      Clinton, MS 39056

In the spaces below, write the name of the person(s) you want the book to be autographed to, and how you want it personalized.

Example:  To Mary..."My Sister and Best Friend"

                For Susan..."The Best Teacher in Arkansas"

Or any other way you want your book personalized.