MAIL ORDER FORM

                            HOLOGRAPHIC STUDIOS
                            Web Orders
                            240 East 26th Street
                            New York, NY 10010
                            FAX:212-481-8645

                                ORDER FORM
                          
                          (minimum order $20.00)
 
  Name:______________________________             Date:_______________
  
  Ship To:___________________________
 
  ___________________________________
  
  ___________________________________             P.O.#:_______________
  
  E-Mail:____________________________             
       
  Phone:_____________________________             
       
_________________________________________________________________________
|Qty  | List No. |           Description              | Size   | Price  |
|_____|__________|____________________________________|________|________|
|     |          |                                    |        |        |
|_____|__________|____________________________________|________|________|
|     |          |                                    |        |        |
|_____|__________|____________________________________|________|________|
|     |          |                                    |        |        |
|_____|__________|____________________________________|________|________|
|     |          |                                    |        |        |
|_____|__________|____________________________________|________|________|
|     |          |                                    |        |        |  
|_____|__________|____________________________________|________|________|
|     |          |                                    |        |        |
|_____|__________|____________________________________|________|________|
|     |          |                                    |        |        |
|_____|__________|____________________________________|________|________|
                                                      |        |        |
                                       Sub-Total      |________|________|
                                                      |        |        |
         (NY residents only add 8.25%) Tax            |________|________|
Shipping UPS Groundtrack(US only)$20.00 for 60 degree,|        |        |
$25 for 120 & 240 degree, for 360 displays add $40.00 |________|________|
For film only orders add $15.00 for shipping          |        |        |
                                       TOTAL          |________|________|

I have included a check_______   I have included a money order_______

Credit Card Number:________________________    Expiration Date:___________

Please allow 2 weeks for delivery unless Express Delivery is requested.
Please allow 1 week additional for checks to clear.

For International, Faster Shipments, or Other Shippers:
(If you specify a shipper and class of service please include your account number)
Billing or Shipping Instructions__________________________________________

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