ORDER FORM - Women Make Movies

ORDER FORM
Send orders to: WOMEN MAKE MOVIES
115 West 29th Street Suite 1200 New York, NY 10001
Tel: (212) 925-0606 x 360, Fax: (212) 925-2052, Email: [email protected]
CUSTOMER INFORMATION
Have you previously ordered from WMM?
__ No
__Yes
If yes, what is your customer number? ___________
(on catalog mailing label)
TITLES
Title(s)
Format
List Price (all prices subject to change)
Downloadable press kits and photos are available for selected titles at wmm.com
PAYMENT
All orders must be accompanied by a purchase order or pre-payment.
Credit Card __ Mastercard __ Visa Card #: _________- __________ - __________ - __________
Exp. Date: ____ /____ CVV2 Code _________ (3 digits on back of card)
Institutional Check __Enclosed __ In the Mail
(personal checks not accepted)
Purchase Order (please fax with order form) __ Attached __ In the Mail
SHIPPING AND HANDLING
See the ordering information at wmm.com for shipping and handling charges. NOTE: We cannot ship to a PO Box; it must be a street address.
BILLING ADDRESS
SHIPPING ADDRESS
Name:
Name:
Institution:
Institution:
Department
Department:
Address:
Address:
Telephone:
Telephone:
Fax:
Fax:
Email:
Email
Contact for questions about this order? __ Billing __ Shipping __Other
If Other, please provide the following: Name _________________________ Phone______________ Email_______________________________
How did you learn about the title(s) you are purchasing today?
__Conference
__Film Festival
__Flyer/Postcard
__Search Engine
__Listserv
__Other Website Link
__Review/Publication
__TV
__WMM Catalog
__WMM Email
__Social Networking Site
__Other (please specify)_______________________________________________________________________