Summer Book Box (and Brain Bag) Request Form
Email address *
PayPal Email Address (if different from above) *
Your answer
Are you a new or existing customer?
How many $40 brain bags would you like to order? *
How many $25 Mini Book Boredom Buster Bags would you like to order? *
How many $60 Mini Book Boxes would you like? *
How many $100 Mini Book Boxes would you like? *
Brain Bag Choices (or type Surprise me and continue below about your readers) If not ordering a Brain Bag, type N/A and continue below to Reader(s): *
Your answer
Reader #1 First Name, Age & Interests: *
Your answer
Reader #2 First Name, , Age & Interests: *
Your answer
Reader #3 First Name, Age & Interests: *
Your answer
Reader #4 First Name, Age & Interests: *
Your answer
Genre/types of books to EXCLUDE from Book Boxes: *
Your answer
Special requests? (favorite books and/or list Usborne & Kane Miller books already owned to avoid duplicates) *
Your answer
Would you like to pay an additional flat rate of $7 per month for Priority Mail (3 day delivery), (one time for Brain Bag)? *
Contact info
Your name *
Your answer
Phone number *
Your answer
Facebook Name *
Your answer
Preferred contact method *
Required
Would you be interested in Hosting your own party to earn free and half priced books this fall/winter? *
Referred by a friend? *
If so, who referred you? *
Your answer
Questions and/or Comments: *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.