|
|
If You Can Dream It, We Can Help You Achieve It!
|
|
E.F.S. ONLINE PUBLISHING SUBMISSION FORM
Please Type or Print Neatly & Legibly
- What is the name of your work or works?
________________________________________________________________________________________
_______________________________
- What information would you like on your cover jacket?)
(Note: Cover Jacket is the information you use in encouraging readers to actuallybuy your book.)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
- Please provide information for your Bio.(Note: Bio includes info about you that youwant readers to know.)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
- Specify exactly which 1 or 2 pagesfrom your book that you want used inthe Free Preview section.
(Note: Preview is a 1 0r 2 page excerptfrom the manuscript you display for thereaders to read.)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
- Which word processing package did you use-- i.e., Microsoft Word or Word Perfect?
_______________________________________________________________________________________
_______________________________________________________________________________________
- How many diskettes did you enclose?
_______________________________________________________________________________________
_______________________________________________________________________________________
- How many pages are in your book?
_______________________________________________________________________________________
_______________________________________________________________________________________
I hereby request that the works listed above be included in the E.F.S. ONLINE PUBLISHING listings. I have enclosed:
- Initial Set-Up Fee of $____________per work, plus
- The first six months of maintenance fees of $____________($15.00 per month, per work), plus
- An estimated scanning charge of $___________(Estimated at $___________per page)
Total Payment Is: $____________
PAYMENT OPTIONS:
Option 1: I have enclosed my check for $____________.
Option 2: I hereby authorize E.F.S. ONLINE PUBLISHING to charge $____________ to my:
VISA - Account Number:
___________________________________________
Expiration Date:
___________________________________________
MasterCard - Account Number:
_____________________________________
Expiration Date: ______________________________________
Discover - Account Number:
_________________________________________
Expiration Date: __________________________________________
Name As Shown On Card:___________________________________
Signature of Author_________________________________________
Date________________________________________________________
Telephone Number_____________________________________________
|
|
|
|
