Chanticleer Book Reviews 
c/o Delta Latitude, L.L.C.                                                 
1050 Larrabee Avenue 
Suite 104, #334 
Bellingham, WA, 98225 
 
Are you submitting this work as a:   
p  Contest Entry $45 Division and Category: ___________________________________________    
p  Standard Review $325 (6 – 9 weeks after receipt of work) 
p  Express Review   $150 extra (3 – 5 weeks after receipt of work) 
p  Manuscript Review $395 (6 – 9 weeks after receipt of work) 
p  Manuscript Express Review $520 (3 – 5 weeks after receipt of work) 
p  Great Beginnings Winter Contest $15 p Great Beginnings Summer Contest $15.00  
p  Short Stories Summer Reads   p Short Stories Winter/Holiday Reads  $25.00 
 
As per the work that you are submitting, you are the:  
 p Author      p  Publisher     p Publicist     p Media    p  Agent     
 
The work is:      Submission: A Digital File is Required  
 p Self-published    p Published     p  Manuscript/Unpublished p Digital  
 
Genre(s): ________________________________________________________________________________ 
 
Title of Work:  ___________________________________________________________________ 
Sub-title: ________________________________________________________________________________ 
ISBN: ____________________________________   Year Published _________________________________ 
Publisher’s/Imprint’s Name: ________________________________________________________________  
Email: _____________________________________Website: _____________________________________ 

Contact Information: 
Author’s Pen Name:_______________________________________________________________________ 
First Name: ______________________________ Last Name: _____________________________________ 
Email: __________________________________ Website: ________________________________________ 
Twitter:________________________ Social Media: G+ or FB______________________________________ 
Address: _________________________________________________________________________________  
Phone Number: __________________________   Alt. ____________________________________________ 

Fee Payment 
p PayPal Last six digits of transaction & amt. _______________  p Square Up & Amt. ______________  
p  Check is enclosed $_________Date:________________ Check No. _____________________________ 

Acceptance of Chanticleer Book Review Terms 

p I have read and agree to the Chanticleer Book Reviews Customer Agreement, Guidelines and Terms. 

Signature:                                                     Date: