Fax Order Form
To place order by fax, simply print out this page and fill out the form below as completely as possible. Take care to include all information about each item for purchase including VHS video format (NTSC or PAL), the desired quantity and price. Please note: Shipping zones and rates information is available on our Ordering Information Page: http://www.fatalemedia.com/orderinfo.html When completed, fax the form to +1-650-745-4009. Be sure to include a daytime phone number so that we may contact you if there is a question.
Items for Purchase   Please fill in the requested information below: Quantity Video Title Format Price  NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD    NTSC    PAL    DVD   California residents add 8.25% sales tax: Shipping & handling (click here to see rates): ORDER TOTAL:
Billing Information
Full Name
Address
Daytime Phone
Evening Phone
Email Address
Shipping Information (if different from above)
Full Name
Address
Payment Information MasterCard    Visa    American Express
Cardholder's Name
Credit Card No.
Exp. Date (mm/yy)
Cardholder's Signature