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BILLING ADDRESS	SHIPPING ADDRESS Please enter the shipping address only if it's different from the billing address.
Full Name: ____________________ Signee of Contract: ____________________ Company: ____________________ Email: ____________________ Address: ____________________ City: ____________________ State: ____________________ Zip/Postal Code: ____________________ Country: ____________________ Daytime Phone: ____________________ Evening Phone: ____________________ Fax Number: ____________________	Full Name: ____________________ Company: ____________________ Address: ____________________ City: ____________________ State: ____________________ Zip/Postal Code: ____________________ Country: ____________________ Daytime Phone: ____________________ Evening Phone: ____________________ Fax Number: ____________________
SHIPPING INFORMATION	PAYMENT INFORMATION
PLEASE SELECT SHIPPING: DOMESTIC ORDERS (1 up to 4 DVDs) ___  ELTA Plain       - € 4,40 ___  ELTA Express - € 5,80 ___  COURIER - € 8,80 (Attica) - € 12,00 (County)      (5 or more DVDs, we ship them FREE!) INTERNATIONAL ORDERS ___  INTL Plain     - 12 Days -    € 14,50 ___  INTL Express -  6 Days -    € 23,50 ___  INTL Courier -   3 Days -    € 41,00	____ Visa         ____ MasterCard Card Number: _____________________ Expiration Date: ___ / ________ Name on Card: ____________________
By submitting this order form (2 pages) I do hereby certify that I am at least 18 years of age, authorize the debit of my credit card by "DVD-GREECE" for the Grand Total amount: __________ EURO, and that all information provided is correct. I understand that credit card fraud will be prosecuted to the fullest extent of the law. Authorization Signature: _______________________________ Print Name: __________________________  Date: ________ Note: According to latest Bank's instructions, please send a copy of your Credit Card as well, along with this form. Please fax this completed order form to: +(30) 210 213-4822