Publishing Agreement Form

Publishing Agreement Form
Please fill in the fields below.
Author
Full Name
First NameLast Name
Birth Date
DayMonthYear
Current Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Book
Book Title
Plot Description
Page Count (min. 50)
Book Cover
(If applicable)
Cancelof
Communication
Phone Number
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Email Address
Twitter
(If applicable)
How did you hear about us?
Other:
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I Agree
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Author