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Name______________________________________________________Date_________________________________
Address_____________________________________________________________________________________________
Home Phone__________________________________________Cell____________________________________________
Email_____________________________________________________
Number of books ordered________________$23.00 each book -- Total enclosed
$__________________
( $19.95 + $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 the World
Or any other way you want your book personalized.
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