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Your Full Name *
Pseudo Name (Pen Name) *
Email (primary address for correspondence) *
URL (your website address)
Date submitting manuscript information *
Phone Number & best time to contact you *
Book Title (include sub-title) *
Genre (Fiction, Non-Fiction, Inspiration, New Age, etc...) *
Word Count *
Document Type (MS Word, WordPerfect, RTF) *
Desired Binding (Hardcover, Paperback, Ebook) *
When are you planning to publish? *
Will we be editing your manuscript? If no, make sure it is professionally edited. * Yes No
Will we be applying for copyrights on your behalf? * Yes No
Will you need an Index for this book (nonfiction titles only)? * Yes No
Do you have other published works? * Yes No
If you have other published works list titles and ISBNs for them.
Do you have forthcoming titles. If yes, list them.
Do you want a customized cover for this title? * Yes No
Do you want this title announced to the book industry? * Yes No
Where will this book be placed (private sales, seminars, retail stores, internet, library, worldwide) *
What will be the approximate size of your first print run? *
What printing method would you like to use (offset, POD)? *
List any questions, comments, or concerns that you have.


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