Simple Countdown Widget Order Form

    Your Name (required)

    Your Email (required)

    Your Website

    Book Information:

    Please provide me with as much information as you can about the Book that you're requesting a countdown timer for. 🙂

    Book Title (required)

    Author (required)

    Release Date (required)

    Book Synopsis:

    Goodreads Link

    Pre-Order Links (if available):



    Barnes & Noble



    The Book Depository

    Any other retailers? Smashwords, Indiebound, etc?

    Book Cover Art
    Please must be at least 250px wide (but would prefer as high-res as possible)

    Anything else?

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