Credit Card #:___________________ Visa [__] MC [__] AE [__] DC [__] Bank Name on Card:_____________________ Exp. Date: _________ Customer #:______________________________________________ Name:__________________________________________________ Street Address:___________________________________________ City:______________________________ State:______ Zip:________ Country:______________________ Email: ___________________ Phone #:_______________________ Fax #:____________________ Format: = DVD [__]    Blu-Ray [__] Please list TITLES, STOCK NUMBERS and PRICES below: 1.)_______________________________ #__________ $________ 2.)_______________________________ #__________ $________ 3.)_______________________________ #__________ $________ 4.)_______________________________ #__________ $________ 5.)_______________________________ #__________ $________ 6.)_______________________________ #__________ $________ 7.)_______________________________ #__________ $________ 8.)_______________________________ #__________ $________ 9.)_______________________________ #__________ $________ 10.)______________________________ #__________ $________ 11.)______________________________ #__________ $________ 12.)______________________________ #__________ $________ 13.)______________________________ #__________ $________ 14.)______________________________ #__________ $________ 15.)______________________________ #__________ $________ Regular shipping Costs: $3.49 per shipment, plus .99¢ per DVD or Blu-Ray. Foreign Shipping Charges: Air Mail Priority Air Mail. Sorry, there is no free shipping for foreign orders. Please printout this form, fill in the blanks, and FAX it to: 800-2-FAX-MOVIES Foreign Orders FAX: 714-773-5409 Excalibur Films 578 Explorer St. Brea, CA 92821-3108, U.S.A. To order by Phone: 800-BUY-MOVIES Foreign Orders Phone: 714-773-5855 Thank you for your order! All information will be held in the strictest confidence. ~ Virginia Beaver, Vice President