FLIKKAFILMZ: Order Form

ORDER FORM FLIKKAFILMZ

'From the strange to the unusual ...on dvd'
P.O. Box Toronto ON CANADA
email / inquiries@flikkafilmz.com Téléc. www.flikkafilmz.com

Please send me the following / Veuillez me faire parvenir

QUAN. ITEM CODE ITEM NAME COST/COÛT _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ _____ _____________________________________________________ ___________ Subtotal / Total partiel ___________ GST add 5% / Ajouter 5% de TPS ___________ Ontario only add PST 8%/Ajouter 8% de TVP l’Ontario seulement ___________ Postage & Handling: __ Courier, OR __for Express Post mail $ ___________ TOTAL ENCLOSED ___________ SHIP TO: Name______________________________________________________________ Address___________________________________________________________ City_________________________ Prov._______ Postal Code______________

Methods of payment (check only one) / Modalités de paiement (cochez une seule case) to: Flikkafilmz
1. ___ Certified chèque certifié 2. ___ Money order / mandat-poste
3. ___ Charge to my / Veuillez débiter mon compte VISA __ Mastercard __

Card number / carte numéro Expiry date / date d’expiration
__________________________________________ __________________

Signature____________________________________________

Age_____ I am 18 years of age or older and request this material for my own private use. This material does not violate the standards of my community.