ALBERT FISH MERCHANDISE ORDER FORM

Please print, write-in information, and send to:

John Borowski
P.O. Box 607085
Chicago, IL 60660

QTY

____ Albert Fish DVD $14.95

Order sub-total: $_______________________________

*Sales tax (1.25%): $___________________________________

Shipping (choose one)

____USPS, First-class (US Only) Free

____USPS, First-class (Canada Only) $6

____USPS, (International) $13

Order Total: $__________________________________

SHIPPING ADDRESS

Name:________________________________________

Address:______________________________________

City/State/Zip:__________________________________

Country:______________________________________

Phone:____________________ Email:______________

Please include check or money order payable to: John Borowski

*(IL residents only)

THANK YOU FOR SUPPORTING INDEPENDENT FILM.