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  1. FOUR PALMS ROYALTY FREE DIGITAL VIDEO ®
  2.  
  3.                                 ORDER FORM
  4.  
  5. Shipping Instructions(please print)
  6.  
  7.  
  8. _______________________________________________
  9. NAME
  10.  
  11.  
  12. _______________________________________________
  13. ADDRESS (NO P.O. BOXES)
  14.  
  15.  
  16. _______________________________________________
  17. CITY                  STATE             POSTAL CODE            COUNTRY
  18.  
  19.  
  20. _______________________________________________
  21. DAYTIME PHONE NUMBER    
  22.  
  23.  Title                                                              PRICE      UNITS         TOTAL
  24.  
  25. Aviation                                                    $ 149.99    _______        ________
  26. Bridges                                                      $ 149.99    _______        ________
  27. Highways                                                 $ 149.99    _______        ________
  28. Marine                                                          $ 149.99    _______        ________
  29. Rail                                                                     $ 149.99    _______        ________                                                                                                                                                                           
  30. Occupations                                       $ 149.99  _______        ________
  31. Professions                                         $ 149.99    _______        ________
  32. Recreation                                         $ 149.99    _______        ________
  33. Relationships                             $ 149.99    _______        ________
  34. Sports                                                            $ 149.99    _______        ________
  35. U.S Scenes                                        $ 149.99    _______        ________
  36. European Scenes                     $ 149.99    _______        ________
  37.  
  38. Any 4 titles above                  $ 499.99    _______        ________
  39.                                                       
  40.  
  41. Complete set of                         $    1299.99    _______        ________
  42. all 12 titles                                                                                                                              
  43.  
  44. Editor's Special Edition        $ 99.99     _______        ________
  45. (50 of our most memorable clips
  46. in .AVI and QuickTime)    
  47.  
  48. Starter Kit                                           $ 24.95      _______        _______ 
  49. (includes 20 clips in .AVI
  50.  and Quicktime, demo,
  51.  catalog, and a coupon)
  52.  
  53. Shipping and handling                                 $ 10.00                                          ________
  54.                                 
  55. Shipping and handling                                 $ 30.00                                        ________
  56. (outside U.S.)                                                                 
  57.  
  58. Overnight delivery (optional)        add              $   5.00            ________
  59.  
  60. (Virginia residents add 4.5% sales tax)                                             ________
  61.  
  62.                                                                                                                                         TOTAL      ________
  63.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
  64. FOUR WAYS TO ORDER
  65. 1. Mail this order form to
  66.     Four Palms, Inc.
  67.    11260 Roger Bacon Dr.
  68.     Suite 502
  69.     Reston, VA 20190
  70.  
  71. 2. Fax order form to        
  72.    703-834-0219
  73.     
  74. 3. Phone toll free 
  75.    1-800-7-4PALMS
  76.    (1-800-747-2567)
  77.  
  78. 4. E-mail to
  79.     fourpalmcd@aol.com
  80.  
  81. PAYMENT                                                                                                                                                                        
  82.                                                                                                                                                                                                 
  83.  Check enclosed                                                                                                                                                                                                                                                                                                                                                                
  84.  Charge my: Visa   MasterCard   Am Express                                                                  
  85.                                                                                                                                                                                                         
  86. ____________________________________________                                                                                                                                                                                                        
  87. CARD N0.        EXP. DATE                                                                                                                                    
  88.                                                                                                                                                                                             
  89.                                                                                                                                                                                                    
  90. ____________________________________________                 
  91. SIGNATURE                                                                                                                                                                           
  92.                 
  93.  
  94.