THE F ZONE  - Video fax order form

1. Name_____________________________________________________

2. Address___________________________________________________

3. City______________________________________________________

4. State, Zip__________________________________________________

5. Phone #___________________________________________________

6. Visa / MC # _______________________________________________

7. Credit Card Exp. Date ______________________________________

8. Number of Copies Requested__________@ $19.95 each

9. Add $3.99 for shipping and handling (CA residents add 8.25% sales tax).

10. Total charge to credit card $__________________

    Print this page and fax to 626 683-9814.   Any questions call 888 683-6455.