Credit Card #:___________________ Visa [__] MC [__] AE [__] DC [__]

Bank Name on Card:_____________________ Exp. Date: _________

Customer #:______________________________________________

Name:__________________________________________________

Street Address:___________________________________________

City:______________________________ State:______ Zip:________

Country:______________________ Email: ___________________

Phone #:_______________________ Fax #:____________________

Format: = DVD [__]    Blu-ray [__]    Adult Sex Toys [__]

   HOLD UNTIL COMPLETE: To wait until the entire order is complete before shipping (to minimize shipping costs).

   SHIP AS SOON AS POSSIBLE: To ship the movies as they become available (extra shipping costs will apply)


Please list TITLES, STOCK NUMBERS and PRICES below:

1.)_______________________________ #__________ $________

2.)_______________________________ #__________ $________

3.)_______________________________ #__________ $________

4.)_______________________________ #__________ $________

5.)_______________________________ #__________ $________

6.)_______________________________ #__________ $________

7.)_______________________________ #__________ $________

8.)_______________________________ #__________ $________

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12.)______________________________ #__________ $________

13.)______________________________ #__________ $________

14.)______________________________ #__________ $________

15.)______________________________ #__________ $________

AGE VERIFICATION

___________________________________________________
I certify by my signature that I am an adult, 18 years of age or older, and that I wish to receive this merchandise for my personal use.


Adult DVD and Blu-ray Shipping:

Regular shipping Costs: $2.60 per shipment, plus $0.49 per DVD. Foreign Shipping Charges: International Rates.

Adult Sex Toys:

Regular shipping costs: Adult sex toys shipping costs will vary by package weight and delivery destination. Most adult toys are eligible for free shipping and free movies. Click here for details. Sex Toys shipping costs: USPS, UPS or FedEx.

All movie orders and eligible toy orders shipping to customers within the continental United States have the option of including free shipping with every $50.00 in purchases. Orders shipped to international locations, Hawaii, Alaska, and U.S. Territories also qualify for free shipping starting at $250.00 in purchases.




Please printout this form, fill in the blanks, and FAX it to:

714-525-6616


Excalibur Films
231 Imperial Hwy Suite 106, Fullerton, CA 92835, U.S.A.

To order by Phone: 800-289-6684

Foreign Orders Phone: 714-773-5855



Thank you for your order!
All information will be held in the strictest confidence.