Book Order Form

Order Form For Inmates at Correctional Ins. Only

Phone orders: Call : 1-229 515-4414. Have your AMEX, Optima, Visa or MasterCard ready.

Fax orders: 1-(305) 378-6253 E-MAIL ADDRESS: semaoutreach@aol.com

*Prices subject to change.

Print and send in the form below with your payment.

ADDRESS FOR:

Inmates at Correctional Ins. Orders Send to:

PO BOX 1340,

Lithonia GA 30058

ORDER PLACED BY

Name:______________________________________________________

Physical Address:________________________________________________

City:___________________ State:_______ Zip:_________

ITEM

___________________________________________________ Cost $_________

I would like to donate $1.00 to support the Inmate Book Program $_________

Sub Total $_________

Shipping: $6.50 for first book and .50¢ for each additional..................... ________

Shipping: Outside US $6.50 for first book and $2.00 for each additional ________

Make a donation to the Inmate Outreach Program Sponsorship Donation $________*

Total $_________

SHIP TO ADDRESS:

Name:______________________________________________________

Physical Address:________________________________________________

City:___________________ State:_______ Zip:_________

_____Payment:________________________________

_____Check -

_____Money Order