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