| This letter is to certify that I _________________________(please print)
under penalty of perjury, declare and affirm that I am over 18 years of age and that it is legal for me to purchase the materials requested.
I also state that I am not an agent nor employee of the U.S. Postal Service, police officer, nor work for, or are employed by any local, city, county, state, government or federal agency. Nor am I ordering or trading for these materials for the purpose of entrapment or any sort of legal prosecution.
I also state that it is legal for me to purchase and have sent to me the adult materials requested, and that it is not illegal in the town, township, city, county, state or province where I reside or having this mailed to.
I am not purchasing/ trading/ acquiring this material to use against the seller/ trader/provider or any other person whatsoever in any conceivable manner.
I will not permit any minor, or other person who might find such material offensive to view or have access to this material.
I fully understand that I am requesting sexually oriented materials. I further state that I am requesting these materials for my own private use and will not trade/ sell these materials to other parties. I am not affiliated with any nationwide distribution company or business of any sort.
!! COMPLETELY FILL OUT ORDER FORM TO ENSURE PROPER SHIPMENT !!
Please print out this form, fill it out neatly, attach cash or money order, (NO CHECKS) Please Sign: ___________________Date:_______ Date of Birth:________________ Ship To: (Please Print) ___________________________ ___________________________ ___________________________ Product Order QTY____ TITLE_____________________________________________ PRICE_________ QTY____ TITLE_____________________________________________ PRICE_________ QTY____ TITLE_____________________________________________ PRICE_________ QTY____ TITLE_____________________________________________ PRICE_________ E-Mail ___________________________________ TOTAL________ |