Order Form

Please print this page, fill out the form and mail to:

Fastrak Press
6595 Castlebay Court
Highland, MD 20777-9789

Item	Price	Quantity	Total
By His Side - Life and Love after Stroke	$15.95
If Shipping within Maryland, add 5% sales tax	Add Sales Tax
Add shipping as follows: 1 book : $3.50 Each additional book: Add $1.00	Add Shipping
	Total Enclosed
If you would like your book autographed, please indicate the name of the person and any special message you would like.	Make Check payable to: Fastrak Press Please do not send cash Orders will be mailed within 24 hours of receipt of check. Thank you for your order.

Your Name____________________________________________________________________
Address______________________________________________________________________
City_____________________________________State_______________Zip_______________
Phone____________________________Email_______________________________________
Please provide phone or email in case of questions)

Shipping address (if different):

Name________________________________________________________________________
Address______________________________________________________________________
City_____________________________________State_______________Zip_______________
Phone____________________________Email_______________________________________