Book Order Form

Please enter the following information to purchase one or more copies of My Mothers Table, The Menu, and Me.  You may wish to print this form to your printer (using your file pull-down menu) if you want to order by mail and/or before submitting the order to Madlene's Market.  It is important that you specifically fill out all required items (indicated by **) and all of your contact information

ORDER INFORMATION:

How did you hear about this website? (please check one box and fill in blanks, if required) 
    Church (name**)   web referral (web site name**)   
    A friend   Just Web Surfing
**Required information, if applicable, so that agreed "commissions" are paid to certain churches and other charitable organizations.

Quantity of Books Ordered:   

Pricing:
     1-9 -- $14.95 each; 10+ -- $12.95 each;  50 + (contact us for special quote)
     Shipping/Handling:  U.S./Canada - $2.95/book;  Other/International - $6.95/book
     Please allow 4 to 6 weeks for delivery.  

To order by Mail, complete and print out this form and send form with your check payable to:
                          Marston Webb International
                          60 Madison Avenue, Suite 1212
                          New York, NY  10010

To order electronically and charge your credit card, please fill out the following:
     Type of Card (please select one):   
     Credit Card Number:  
     Exp. Date: (mm/dd/yyyy) //
     Name on Credit Card: 
     Billing Street Address:
     City:   State or Province:   Zip/Mailing Code:
     Country: United States  Canada   Other (Please Specify)

Delivery Instructions: (If other than to Contact Address below):  
       y

Comments:
          Enter any comments, special requirements or questions in the space provided below:
     

Tell us where to send your order and how to get in touch with you:

Name**   
E-mail** 
Tel**    
FAX      
Company  
Address1 
Address2 
City     
State     ZipCode 
Country  
**Required fields.
Please contact me for a special quote.

    (Use your File Pull-Down Menu to print this form before submitting)


Copyright © 2003 Madlene's Market.  All rights reserved.
Revised: June 21, 2006.