SX Video Order Sheet

SX Video

3470 Adams Ave., San Diego, CA 92116
Direct (619) 299-8041 Fax (619) 299-8046
Toll Free (866) 866-4SX2

Make Checks Payable To:
SoCal Media Inc.

PAYMENT METHOD

VISA

MASTER CARD

AMEX

DISCOVER

MONEY ORDER

CHECK

(ALL PERSONAL CHECKS WILL BE HELD FOR 10 DAYS)

CREDIT CARD #

EXP DATE

NAME
ADDRESS
CITY
STATE
ZIP
EMAIL ADDRESS
	SHIP TO A DIFFERENT ADDRESS FROM THE ADDRESS ABOVE
NAME
ADDRESS
CITY
STATE
ZIP

WE MUST HAVE YOUR SIGNATURE BEFORE WE CAN FILL YOUR ORDER

By signing below, I hereby certify that I am at least 18 years of age and am ordering adult oriented material for my personal, private use. Further, I indemnify SX Video from any damages resulting from the misuse of these products.

I request that SX Video send brochures and catalogues to me in the future.

PLEASE SEND ME THE FOLLOWING ITEMS
ITEM #	VIDEO TITLE	QTY	PRICE












ORDER SUB TOTAL

SHIPPING AND HANDLING CHARGES
UPS Ground: (USA ORDERS ONLY)	$6.50 for 1st item and $1.95 for each additional item - takes 5 - 6 Business Days
UPS Next Day: (USA ORDERS ONLY)	$35.00 for 1st item and $5.00 for each additional item - Next Day Delivery
International: (NON-USA ORDERS ONLY)	$15.00 for 1st item and $5.00 for each additional item
NO FOREIGN CHECKS ACCEPTED CASH IS SENT AT BUYER'S RISK
< ORDER SUB TOTAL	$
+ 8.00% SALES TAX (California only)	$
LESS CREDIT (if any)	$
ORDER NET	$
+ POSTAGE (see above)	$
= TOTAL ENCLOSED	$