Contact Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Country
Email Address
Crossroad's Title
Author
ISBN
Excerpt length (total word count and/or page number)
The excerpts ( if less than 3000 words )
Title of your publication
Author of your publication
Total word count of your publication
Territory of your publication distribution ( North America, US, world, etc):
Publication date
Estimated print run
Retail price of your publication
Website address (if any)
Please list other titles you have requested with The Crossroad Publishing Company (if any)
Notes:
