Credit Card #:______________________ Visa [__] MC [__] AE [__] Bank Name on Card:_____________________ Exp. Date: _________ Customer #:______________________________________________ Name:__________________________________________________ Street Address:___________________________________________ City:______________________________ State:______ Zip:________ Country:______________________ E:Mail #: ___________________ Phone #:_______________________ Fax #:____________________ Format: =      [_____]-VHS (NTSC)      [____]-DVD 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: $2.99 per shipment, plus 99¢ per VHS Tape, and .49¢ per DVD. 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 3621 W. Commonwealth, Fullerton, CA. 92833 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

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