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Print this form by clicking the button below. After you complete it, please mail or fax your order with your VISA, MasterCard or American Express information. We also accept personal checks and money orders. Your print-out will be used to process the order. The Book By You address and fax information is available at the bottom of this page.
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Heroine's Characteristics
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| First name: ______________________________ (Usual first name - e.g. Jen versus Jennifer. Only capitalize first letter!) |
Last name:
______________________________ (Use maiden name if you plan to select a spouse as the hero) |
| Eye color: (Check one) |
| __ blue |
| __ brown |
| __ hazel |
| __ green |
| __ gray |
| __ black |
| Hair color: (Check one) | |
| __ brown | __ aubern |
| __ dark brown | __ red |
| __ light brown | __ silver |
| __ blonde | __ salt and pepper |
| __ black | __ gray |
| Hair length: (Check one) |
| __ short |
| __ shoulder length |
| __ long |
| Hair style: (Check one) |
| __ straight |
| __ wavy |
| __ curly |
| Figure: (Check one) |
| __ slim |
| __ athletic |
| __ curvaceous |
| __ voluptuous |
| Favorite drink: (Check one) | ||
| __ white wine | __ beer | __ bloody mary |
| __ gin & tonic | __ rum & Coke | __ rye and Coke |
| __ rye & ginger ale | __ screwdriver | __ tequila |
| __ tequila sunrise | __ daiquiri | __ Long Island ice tea |
| __ zombie | __ ginger ale | __ cranberry juice |
| __ tomato juice | __ bloody caesar | __ Coke |
| __ red wine | __ rye | __ coffee |
| __ martini | __ vodka & tonic | |
| __ scotch | __ mai-tai | |
| __ pina colada | __ root beer |
| Pet: (Check one) |
| __ dog |
| __ cat |
| Pet name: ______________________ (Smokey is the default if no name is entered) |
| State/Province where heroine resides : ______________________________ (Please capitalize first letter and put full name, not short form) |
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Heroine's Female Friend
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| Friend's first name: ____________________ |
Last name: _______________________ |
| Eye color: (Check one) |
| __ blue |
| __ brown |
| __ hazel |
| __ green |
| __ gray |
| __ black |
| Hair color: (Check one) | |
| __ brown | __ aubern |
| __ dark brown | __ red |
| __ light brown | __ silver |
| __ blonde | __ salt and pepper |
| __ black | __ gray |
| Hair length: (Check one) |
| __ short |
| __ shoulder length |
| __ long |
| Hair style: (Check one) |
| __ straight |
| __ wavy |
| __ curly |
| Figure: (Check one) |
| __ slim |
| __ athletic |
| __ curvaceous |
| __ voluptuous |
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Hero's Characteristics
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| First name: ______________________________ (Usual first name - e.g. Jen versus Jennifer. Only capitalize first letter!) |
Last name:
______________________________ (Use maiden name if you plan to select a spouse as the hero) |
| Eye color: (Check one) |
| __ blue |
| __ brown |
| __ hazel |
| __ green |
| __ gray |
| __ black |
| Hair color: (Check one) | |
| __ brown | __ aubern |
| __ dark brown | __ red |
| __ light brown | __ silver |
| __ blonde | __ salt and pepper |
| __ black | __ gray |
| Hair length: (Check one) |
| __ short |
| __ shoulder length |
| __ long |
| Hair style: (Check one) |
| __ straight |
| __ wavy |
| __ curly |
| Body Type: (Check one) |
| __ slim |
| __ athletic |
| __ muscular |
| __ heavy set |
| __ cuddly |
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Personalized Cover Info
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| Name(s) for the book cover: (Check one) |
| __ heroine's first & last name |
| __ hero's first & last name |
| __ heroine & hero's first names |
| Note: If you've selected "heroine's first & last name," and you entered a maiden name for the heroine's last name at the start of the questionnaire, the maiden name will appear on the cover. You may wish to select "heroine & hero first names" instead'. |
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Contact and Shipping Information
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A) Primary/Billing Contact: |
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| First Name: ________________________ Last Name: __________________________ | |||
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(If ordering by credit card, use first and last name as they appear on the card)
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| Street Address: |
____________________________________________________
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City: __________________________ State or Province: ___________________________
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Zip/Postal Code: __________________________
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Country: _______________________________________
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| Home telephone: (____ ) ______________________ (include area code) | |||
| Work telephone: (____ ) ______________________ (include area code) | |||
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(One of either home or work number is required)
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| Fax (____ ) ______________________ (optional) | |
| Email ______________________ (required) |
| B) Shipping Address (only necessary if different from above): | |||
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Name (First, Last):
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____________________________________________________
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Street Address:
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____________________________________________________
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City: __________________________ State or Province: _____________________
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Zip/Postal Code: __________________________
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Country: _____________
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C) Would you like an extra copy of your book? Many customers request an additional copy of the book they've ordered. Perhaps the friend in the story would appreciate a copy? Maybe you want your own book? __ Yes __ No If you've answered "Yes" for an additional copy, both books will be sent to the address you specified above (contact or alternate shipping address). If you prefer the extra copy to be sent to a different address, please enter it here: |
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Alternate Shipping Address for Extra Copy: |
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Name (First, Last):
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____________________________________________________
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Street Address:
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____________________________________________________
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City: __________________________ State or Province: _____________________
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Zip/Postal Code: __________________________
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Country: _____________
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Delivery Method
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| (Check one) |
| __ First Class Mail: all of USA & Canada (no additional charge) |
| __ Priority Post: continental USA ($5 additional charge) |
| __ Courier Express: continental USA ($10 additional charge) |
| For Orders Outside the Continental USA and Canada |
| __ Priority Post: Canada, Alaska, Hawaii, Puerto Rico ($8 charge) |
| __ Courier Express: Canada, Alaska, Hawaii, Puerto Rico ($15 charge) |
| __ International Air Mail: outside of USA & Canada ($7 charge) |
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For orders shipped to countries outside North
America there
is an additional $7.00 charge for shipping & handling. Estimated delivery time for destinations outside of North America is approximately six weeks. Shipments are by Federal Express, UPS or Airborne Express based on delivery location If selecting the Courier Express delivery option do not use PO Box for address Payment Information |
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Payment Information
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Method of Payment (choose one) __ Check or Money Order Enclosed (Mail orders only)
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__ Credit Card (We accept VISA, MasterCard or American Express)
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Questions? Call 1-877-898-1440 or publish@bookbyyou.com