GREAT WORM EXPRESS DISTRIBUTION -- Order Form

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| Item name/description                | Issue   | Qty     | Price   | Total   |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       |         |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
+--------------------------------------+---------+---------+---------+---------+
|                                      |         |         | x       | +       |
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| Add $1 postage for every 3 zines, rounded up   |         | x 1.00  | +       |
+------------------------------------------------+---------+---------+---------+
| Ordering books: add $3.  Ordering Videos: add $5                   | +       |
+--------------------------------------+---------+---------+---------+---------+
| Grand total                                                        | =       |
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| Your Email address:                                                          |
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| Send the zines to:                                                           |
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Send this order form to:

Great Worm Express Distribution
PO Box 19013, 
360A Bloor St. W. 
Toronto, ON  M5S 3C9
CANADA