New Revelation Inc.

To order a copy of the manuscript "Rosemary - Daughter of God", please print out this form, fill it in, sign it and fax it to: 01-613-342-0232. Your credit card will be billed for one of the following amounts:

For shipments to:	Please circle one only
Alberta, British Columbia, Manitoba, Saskatchewan, Ontario, Quebec, P.E.I., Yukon Territories, Northwest Territories and Nunavut	$32.62*
New Brunswick, Nova Scotia & Newfoundland	35.06*
U.S. Destinations	$32.99*
International & Overseas Destinations	$41.74*
E-Mail version (text only)	$19.95*

*Total includes shipping, handling and all applicable taxes. All prices are in Canadian funds. Delivery should be expected within 3 weeks of receipt of your request. For mail orders, please forward bank draft or money order to

Cecil Keith Adams New Revelation Inc.
RR#3,
Prescott, Ontario K0E 1T0
Canada

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The issuer of the card identified on this item is authorized to pay $------------------------- upon proper presentation. The cardholder promises to pay the issuer of the charge card identified the amount stated in accordance with the issuers agreement with the cardholder.
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"All data collected herewith will be used solely to expedite shipment of your order. To achieve this goal will require sharing certain data with our printer/shipper (Mail Boxes Etc., Canadian Centre #79), selected commercial carriers, and/or charge card companies/banks. Your data will never be rented/sold, given away free, or otherwise shared with anyone else - save and except those covered by government regulations/requirements."