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 [__] Flesh Drives [__]
 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)
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Please list TITLES, STOCK NUMBERS and PRICES below:
1.)_______________________________ #__________ $________
2.)_______________________________ #__________ $________
3.)_______________________________ #__________ $________
4.)_______________________________ #__________ $________
5.)_______________________________ #__________ $________
6.)_______________________________ #__________ $________
7.)_______________________________ #__________ $________
8.)_______________________________ #__________ $________
9.)_______________________________ #__________ $________
10.)______________________________ #__________ $________
11.)______________________________ #__________ $________
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.
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Adult DVD, Blu-ray, & Flesh Drive Shipping:
Regular shipping Costs: $3.09 per shipment, plus $0.99 per DVD/Flesh Drive. 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 $150.00 in purchases.
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Please printout this form, fill in the blanks, and FAX it to:
800-232-9668
Foreign Orders FAX: 714-773-5409
Excalibur Films
578 Explorer St. Brea, CA 92821-3108, 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.
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