Rich-Heape Films, Inc.
FAX/MAIL Order Form

Print as many copies of this form as you need, complete them and fax to (214) 696-6306

Your Name ________________________________________

Phone Number____________________

Address ______________________________________________

City _______________________ State _____ Zip _____________

Ship to (write "same" if same as above) ________________________________________

Address ______________________________________________

City _______________________ State _____ Zip _____________

Card Type (circle one)    MasterCard    Visa    American Express    Discover

Credit card number _______________________________ Exp. Date _______________

Product_____________________ Quantity___ DVD VHS CD Book (circle one)

Product_____________________ Quantity___ DVD VHS CD Book (circle one)

Product_____________________ Quantity___ DVD VHS CD Book (circle one)

Product_____________________ Quantity___ DVD VHS CD Book (circle one)

Product_____________________ Quantity___ DVD VHS CD Book (circle one)

Product_____________________ Quantity___ DVD VHS CD Book (circle one)

*Please include $5.00 shipping for the first item and $3.00 for each additional item.

*Shipping______________
  Total_____________