Please
print this form, fill out, and mail to address below
with donation
Name ________________________________________________________
Address ______________________________________________________
____________________________________________________________
How did you hear about us?_________________________________________
____________________________________________________________
Would you like to be notified of future film releases?__________________________
If so, please provide e-mail contact_____________________________________
Number of Copies_____
Format (Circle One)
DVD-NTSC-USA and Canada
DVD-PAL-Europe and Australia
VHS-NTSC-USA
and Canada
VHS-PAL-Europe and Australia
For multiple formats, please fill out separate forms.
Please
include a check for:
$20.00 + 2.00 shipping and handling Per Copy (USA)
$20.00 + 6.00 shipping and handling Per Copy (Europe and Australia)
US funds only please
Total
Amount Encolsed:_________________________________
Mail
check and make payable to:
Rattle The Cage
Productions
1126 S. Federal Hwy. Suite 288
Fort Lauderdale, FL 33316