Printable Order Form

Name: ____________________________________________


Address: __________________________________________


City:_____________________ State: _______


Zip/Postal Code: _________________


Country: ____________________



Book Title: Going Down Memory Lane
ISBN#1413714013 #_______ of Books at $16.95 each $__________ (total before tax and shipping)

Maryland Residents Add 5% Tax _________

U.S. Shipping: Add $3.00 for first copy and $0.50 for each additional copy__________
Canada Shipping: Add $3.00 for first copy and $2.00 for each additional copy __________
International Shipping: Add $8.00 for first copy and $5.00 for each additional copy ________

Total _____________

I will be paying by (circle one): Credit Card Check Money Order

Credit Card Information:

Card Name: ______________

Card Owner's Name (exactly as it appears on card): _______________________________

Card Number: _______________________

Expiration Date: ______________________


Please make check or money order payable to: Publish America, Inc.
and mail to:

Publish America, Inc
P.O. Box 151
Frederick, MD 21705