Ebook Pre-Order Form

Concerned about security? Click the VeriSign logo at top left.

----------------------------------------------------------------------------------------

Ebook Delivery Email Address -- PLEASE TYPE CAREFULLY

Important: Enter a valid e-mail address. Receipts will be sent to this address.

*E-Mail:

*Re-enter E-Mail:

Select book and format, and enter quantities at right

When the book you order is released, you will be emailed a download link.

Friends and Lovers

Who Am I?

The Two Fears

Modest

Grand Total:

Newsletter

We send out an email newsletter about once a month, providing advance book excerpts, news, special offers, and more. You will always be able to unsubscribe with a click or two.

*Want the Newsletter?

Yes, please sign me up!
No thanks.

Billing Information

*First Name:

same name as on your card

Middle Initial:

same as on your card, if any

*Last Name:

same as on your card

*Address Line 1:

Address Line 2:

*City:

*State:

*Zip Code:

Order Number:

You will complete payment with a credit card or optionally through a PayPal account.

Enter the security code shown above
in UPPER CASE.

Create Your Own Form
using this Template

Want the ability to collect information with an
online form that looks like this one?