MAIL & FAX Order Form
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Name_____________________________________________________________

Street Address___________________________________________________

City ______________________________  State______  Zip____________

Phone(_____)____________  E-Mail_________________________________

Check one: (  ) Check enclosed, (  ) Money Order,
           (  ) Master Card,    (  ) American Express, (  ) Visa

   Name as it appears on your card ______________________________

   Credit card no.________________________________ Exp.__________


       | Qty. |     Description       | Price Ea. |  Total   |
       |      |                       |           |          |
       |______|_______________________|___________|______.___|
       |      |                       |           |          |
       |______|_______________________|___________|______.___|
       |      |                       |           |          |
       |______|_______________________|___________|______.___|
       |      |                       |           |          |
       |______|_______________________|___________|______.___|


   Publication orders sold               Subtotal________.___
   through license to Visual
   Dialogues, exclusive vendors       ** Shipping_______5.00
   for JLA's 100/100 - 3D Object
   Library.                              Sales Tax_______.___ 

                                         Total___________.___
   
                                                       
Signature  _____________________________________ Date ___/___/___

   PLEASE NOTE:
   Your order cannot be processed without your signature and date.


   ** For shipping outside of the continental U.S. and
      Next-Day & 2nd-Day delivery rates please call
      (314) 968-2888 for details.