This is the basic information we need about your organization
or the designated individual to receive the commissions.

Name___________________________________________________________________

Name 2_________________________________________________________________

Address_________________________________________________________________

Address 2_______________________________________________________________

Social security number ____________________________________________________

Or, Federal Employer Number (FEIN)________________________________________
Telephone number________________________________________________________
Email address____________________________________________________________

ORDER FORM

Price per book-------------------------------------------------------$19.84
Shipping and handling-------------------------------------------------4.95
Subtotal---------------------------------------------------------------$24.79

Gift card---------------------------------------------------------No charge
Sales tax (Alabama purchasers)-------------------------------------$.80

Number of books to Alabama purchasers-----________ @ $25.59 = $____________
Number of books to other purchasers----------________ @ $24.79 = $____________
Total remitted----------------------------------------------------------------- $____________
Date______________

Wealthy World Publishing Co.
4205 Harpers Ferry Road
Birmingham, AL 35213
Tel 205-914-6600