1. Print out this form.
2. Fill out the requested information
3. Write out check or money order
4. Mail completed form and check or money order to

. . . . . . . . . . . . . . . .Please send me ____ copies of
$____________ . . . . . The Image and The Likeness $14.95/book

. ____________ . . . . . Add 5% sales tax of $0.75/book (Mass residents)

. ____________ . . . . . Shipping and handling @ $3.50/book

$____________ . . . . . Total (check payable to Pelagian Press)

Name ___________________________________________________________

Address ___________________________________________________________

Address ___________________________________________________________

City State Zip ___________________________________________________________

Please autograph and register the book(s) to:

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________