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Date order placed:
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Ordered by:
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| First Name: |
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| Last Name: |
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| Street Address: |
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| Additional address line (if needed): |
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E-mail address (for shipping confirmation):
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Ship to (if different from "ordered by"):
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| Ship To - First Name: |
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| Ship To - Last Name: |
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| Ship To - Street Address: |
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| Ship To - Additional address line (if needed): |
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| Ship To - City: |
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| Ship To - State: |
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Number of books requested:
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Cost of books alone ( @ $34.95/book ):
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Wisconsin residents add 5.5% sales tax:
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Shipping ($2.50 for first book, $1.00 for each additional book):
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Total cost (books + Wisconsin sales tax + shipping):
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Would you like books signed (Y or N?):
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Please include custom inscription (written by author on title page) if desired:
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| Comments or questions? |
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Send remittance (personal check or money order) to:
Dr. Mike Martin
1113 130th St.
Amery, WI 54001
715-268-5994 (home)
E-mail: mjm59@mymichaeljamesmartin.com
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