Print This Form

Complete and Mail To: League of American Poets 600 Reisterstown Road, Suite 200 G Baltimore, MD 21208

www.poetryamerica.com/publish Email: orders@poetryamerica.com Phone: 410-602-0384 (9:00 - 3:00 EST) Fax: 410-764-7471

Publishing Order Form

Contact Information

Name:________________________________________________

Address_______________________________________________

Apt/Suite ______________________________________________

City ______________________State ______Zip Code__________

Day Phone (_____) ______ ______

Email _________________________________________________

Book Specifications:

You must supply a usable disk which contains your writings in the order you want them to appear.
Please number the pages (the front and back of each page). The Title and Copyright Pages will be Pages 1 and 2.

Number of Pages

Up to 48 Pages______   Up to 64 Pages______   Up to 84 Pages______   Up to 104 Pages______

Number of Books        50 Books______    100 Books______    150 Books______

Design:

Cover

_________ Cover Design Choice (Enter Number)   _____ I have supplied my own artwork.

Interior:

Font _________ Font Name

Text Alignment:

Poetry: Alignment must be the same for the entire book     Left:________ Centered:________

Stories: For Short Stories and any Dedication or Introduction pages the text will be Left Aligned.

Payment:

Please submit a check/money order or credit card payment with a 50% deposit to begin the process.
The final half of payment is due with the proof approval.

U.S. FUNDS ONLY Payment Must Accompany Order

_________ Check or Money Order enclosed  (Payable to League of American Poets)

Charge to my: Visa       MasterCard      Discover          AmEx

Acct. Number_____________ _____________ _____________ _____________

Signature____________________________  Expiration. Date _______/______

Authors Name ____________________________

Book Title _______________________________

Author's Signature: ______________________________   Date: ___________