MAIL ORDER FORM.........

[GRINDHOUSE DVDS]

DVD ORDER FORM

ALL PRICES ARE IN LOCAL MONEY - PAYMENT IS BY CASH, INTERNATIONAL
MONEY ORDER, WESTERN UNION MONEY TRANSFER OR MONEYGRAM:

1 DVD $5.00 U.S./$5.00 CDN./4 EUROS/3 U.K. POUNDS
2 DVDS $8.00 U.S./$8.00 CDN./6 EUROS/5 U.K. POUNDS
6 DVDS $20.00 U.S./$20.00 CDN./20 EUROS/13 U.K. POUNDS
24 DVDS $60.00 U.S./$60.00 CDN./62 EUROS/42 U.K. POUNDS

FOR AUSTRALIA/ASIA/AFRICA/LATIN AMERICA/SOUTH AMERICA PAYMENT IS IN
U.S. DOLLARS ONLY:

1 DVD $6.00 U.S.
2 DVDS $11.00 U.S.
6 DVDS $30.00 U.S.
24 DVDS $96.00 U.S.

MAILING COSTS ARE IN THE PRICES!

I DO NOT TAKE "PAYPAL"......DON'T ASK!

PLEASE CHECK YOUR DVD PLAYER MANUAL FOR WHETHER IT'LL PLAY DVD-R NTSC
FORMAT (NORTH AMERICA PLAY - REGION FREE)

PLEASE MAIL TO:

GLENN CHARTRAND,
170 CLEARBROOKE CIRCLE,
REXDALE, TORONTO,
ONTARIO, CANADA
M9W 2G1

TITLES ORDERED:



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---------------------------------------------DVD TOTAL

TOTAL COST---------------------------------

I AM 21 YEARS OLD & WILL PROVIDE PROOF OF AGE IF NEEDED TO SATISFY
CUSTOMS INSPECTION FOR MY OWN COUNTRY.......FOR EXAMPLE.....GERMANY!

I UNDERSTAND THAT I'M BUYING ADULT MATERIAL THAT IS LEGAL IN CANADA &
THAT ALL PERSONS DEPICTED IN THE MATERIAL ARE ABOVE THE AGE OF 18
YEARS
OLD & THE MATERIAL IS FOR MY OWN USE & THAT I'M OVER 21 YEARS OLD:


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DATE OF
BIRTH--------------------------------------------------------------------

NAME & ADDRESS:

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