Between Us Manuscript Assessment Service

165 Belair Road

Torrens Park SA 5062

Australia

 

(Please print to obtain a copy to accompany the manuscript)

 

Name

 

Pseudonym (if used)

Address

 

State

Postcode

Telephone

Fax

Email 

 

Title of manuscript

Approximate word length

Genre/target imprint 

 

In submitting this manuscript for assessment I agree that Between Us Manuscript Assessment Service accepts no liability or responsibility for any loss of or damage to the manuscript. I further agree to be bound by the Conditions of Assessment.

I declare that this manuscript is my own original work.

I enclose return postage and cheque/money order for $……………………….

 

Signature……………………………………………………………………….