MAIL ORDER FORM

Please read our Instructions before filling out this form. Back to List of Integral Images

                            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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© Holographic Studios
June, 1997