This is the new Archive Media Comics Order Form:

---

Name:___________________________________________________

Address:_________________________________________________ Apt #____________

City:___________________________________ State or Province:_____________________

Zip or Postal Code:___________________________ Nation of origin:__________________

Select from the choices below:

___Single issue of REICH CHILD (Circle which issue you want: 1 2 3 ).................$3. 50

___Two issues of REICH CHILD (Circle the two you want: 1 2 3 )..................$7. 00

___All three back issues...........................................................................................................$10. 00

We pay all postage charges inside the United States. Residents of other countries must include a total of $3.00 extra for postage and handling. We are also not responsible for materials seized by customs authorities during international transit, especially in Germany (Deutschland).

*We accept the following methods of payment from US Citizens: Personal Checks, Money Orders, Cash, and Credit Card Payments.

*Canadian Citizens may with: US Currency, Credit Cards, or Money Orders in US funds from the following banks.....Scotiabank or Royal Bank of Canada.

*All other countries must purchase using: US Currency or Credit Cards.

Circle your method of payment and fill in any applicable information below:

Cash Money Order(*) Personal Check(*) Credit Card

CREDIT CARD INFORMATION: (Please Print)

Card Holders Name:_____________________________________________________________

Type of Card: (___VISA) (___Mastercard) Expiration Date:____________

Card Account Number: ( _ _ _ _ ) - ( _ _ _ _ ) - ( _ _ _ _ ) - ( _ _ _ _ )

Signature of Card Holder___________________________________________ Date__________

My signature above authorizes ARCHIVE MEDIA or it's designates/representatives to charge my listed card account for the items I have checked above. I am the rightful and lawful owner of this credit account and have the legal authority to authorize it's use for purchases.

My signature below indicates that I am 18 years or older and aware that the material I have ordered contains depictions of violence and nudity and topics which may be illegal in some countries. I do not hold ARCHIVE MEDIA or it's employees/owners responsible should I be found guilty by authorities for improper display of this material and/or it's redistribution to person(s) not of legal stature to possess or view it. I will not hold ARCHIVE MEDIA responsible should this material be confiscated in transit outside the US borders by foreign customs officials.

SIGNATURE_________________________________________ DATE____________________