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This letter is to certify that I _________________________ (please print) under penalty of perjury, declare and affirm that I am over age 18 and it is legal for me to purchase the materials requested. I ______________________ state I am not an agent or employee of the U.S. Postal Service, Police Officer, work for or employed by any Local, City, County, State, Government or Federal Agency. I am not ordering these materials for the purpose of entrapment or any legal prosecution. I _____________________ state it is LEGAL for me to PURCHASE and have MAILED to me the adult materials requested and it IS LEGAL in the Town, Township, City, County, State where I RESIDE or have this MAILED. I _______________________ am not purchasing this material to use against the seller, provider or any other person in any manner. I_____________________ will not permit any MINOR or OTHERS who might find such material offensive to VIEW or HAVE ACCESS to this material. I ____________________ fully understand that I am requesting SEXUALLY EXPLICIT MATERIALS. I state that I am requesting these materials for my own private use and will not TRADE, SELL or GIVE these materials to other parties. I am not affiliated with any nationwide distribution company or business. (Please print clearly the NAME OF THE DVDs you want to purchase) ___________________________________________DVD PRICE $______________ ___________________________________________DVD PRICE $______________ ___________________________________________DVD PRICE $______________ ___________________________________________DVD PRICE $______________ ___________________________________________DVD PRICE $______________ ___________________________________________DVD PRICE $______________ TOTAL $ AMOUNT OF ALL DVDs $______________ Total # Of DVDs To Ship _____ X $4.00 Handling = $______________ Shipping Charge: 1 or 2 DVDs $4.95 3 or 4 DVDs $7.95 5 or 6 DVD $10.95 Shipping = $______________ TOTAL DVDs HANDLING & SHIPPING AMOUNT $______________ MULTIPLY THE ABOVE AMOUNT BY .90 TOTAL AMOUNT TO SEND WITH YOUR PURCHASE $______________ Please Sign: _________________________ Date:_____________ Date of Birth:_____________ E-Mail Address:________________________________________ Ship To: (PLEASE PRINT CLEARLY) ________________________________________ ________________________________________ ________________________________________ |