GEBACA Literature Order Form

Name*

First NameLast Initial

Email*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Shipping/Delivery Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Group Name/Number*

Books and Medallions (select item checkboxes to see pricing and options and include in order)

Big Red Book

$19.00

Cover Type	Quantity	Price
Hardcover		$19.00
Softcover		$18.00
Spanish Edition (hardcover)		$14.00

Item subtotal:$0.00

12 Steps of Adult Children Step Workbook

$12.00

Version	Quantity	Price
English		$12.00
Spanish		$10.00

Item subtotal:$0.00

Strengthening My Recovery

$10.00

Cover Type	Quantity	Price
Softcover		$10.00
Hardcover		$12.00

Item subtotal:$0.00

Laundry List Workbook

$12.00 Quantity
Item subtotal:$0.00

Loving Parent Guidebook

(spiralbound)

$12.00 Quantity
Item subtotal:$0.00

A New Hope

$10.00 Quantity
Item subtotal:$0.00

Yearly Bronze Medallion

Enter here the total quantity of medallions you want. In the note box at the end of the order, enter how many of each year.

$2.00 Total Quantity (of all bronze medallions being ordered)
Item subtotal:$0.00

Recovery Chip

$1.00

	Quantity
Welcome
6 Consecutive Meetings
1 Month
2 Months
3 Months
6 Months
9 Months

Item subtotal:$0.00

Total

$0.00

For the yearly bronze medallion(s), which year(s) and how many of each year(s) are you ordering? (Write the year first, then the quantity of that year (ie. 1 (5), 4 (10)))*

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Do you have any questions or is there anything you want the literature representative to know?