Mail-in Order Form
Fatale Media, Inc. 1537 Fourth Street, Ste. 193 San Rafael, CA 94901		Customers who wish to pay by check or those who prefer not to use our secure online order form may use this form instead. Just print it out, fill it in and mail it to the address shown on the left. If you have any questions about ordering, call us toll-free at 1-888-5-FATALE (1-888-532-8253). Please note: Shipping zones and rates information is available on our Ordering Information Page: http://www.fatalemedia.com/orderinfo.html
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    Payment by Check (make check payable to "Fatale Media, Inc.")
Cardholder's Name
Credit Card No.
Exp. Date (mm/yy)
Cardholder's Signature