Graduation Book

AD&J Enterprises

4600 FM 1645
Timpson, Texas 75975

936-254-2677
Fax: 936-254-2839

Fill out this form, print and mail it along with your payment. If you wish to pay by credit card, you can fax
your payment information to: 936-254-2839, there will be an extra $1.50 fee for credit card purchases.
You can also call: 936-254-2677 and leave your card information, or leave a message to call you back..

Delivery time is approximately 1 week for credit card orders, 2-3 weeks for check orders. Texas deliveries must pay sales tax.

Your Information: First Name:
Last Name:
Your E-Mail:
Street:
City:
State:
Zip:
Your Phone numbers(To be used only if we have questions): Day:
Extension: Evening: Best Time:


Shipping address if different than above: Name:
Street: City: State: Zip:


Payment Type:

Check | Credit Card

Card number:
Exp. Date:
Security Code:
Name on Card:
Address bill is mailed to:

Signature if mailing:______________________________________________________

Book Information

Standard | Humorous
Graduate First Name:
Name Used (only if you want a different name used in the book:
Last Name:
Male | Female
School:
Date of Graduation:
Degree(optional):
Friends at School (optional):
Family at Graduation(optional):
Teachers(optional):
Dedication:
Book From:


Gift Date:


Graduation Books are $16.99each plus $5.00 shipping/handling per order.

Deliveries to Texas addresses MUST include 8.25% sales tax.

Extra Credit card fee is $1.50.

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