__________________________________________________________________________
Print Full Name

__________________________________________________________________________
Address

__________________________________________________________________________
City Province Postal Code

__________________________________________________________________________
E-mail Address Birth Date (D/M/Y)

1 VISA #_________________________________ Exp. ____/____ 1 Cheque* Enclosed

VISA Cardholder Name_______________________________________________________

Price includes all taxes, postage and handling.
Please allow 4-6 weeks for initial delivery.
*Please make cheques payable to: FAZE PUBLICATIONS INC.
Please note that Faze Magazine is published five time a year.

IF ORDERING FROM:
United States..............................$24.00 (U.S. Dollars) for 10 issues
Outside U.S. or Canada...............$48.00 (U.S. Dollars) for 10 issues