Name_____________________________________________Date______________

Address_____________________________________________________________

Home Phone__________________________Cell____________________________

Email ______________________________________________________________

Number of books ordered_______$20.00 each book--Total enclosed $___________

($16.95 + $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 Mississippi"

Or any other way you want your book personalized.

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