::::: NON-US RESIDENTS ONLY :::::
Print this form and mail in with payment: You may send in a check, money order, or cash. Your video order will be promptly shipped, (usually within 48 hours of order receipt), to the address provided on your order form. |
I, _____________________________, verify that I am over the age of 18 years old and it is permissible in my locality to view adult material on VHS. X________________________________________________________ Valid Email Address: ________________________________ Full Name: ________________________________ Address (Line 1): ________________________________ Address (Line 2): ________________________________ Postal Code / Country: ________________________________ *** Video(s) Purchased: *** (circle choice(s) below):
FORMAT CHOICE - DVD OR VHS (please circle) Amount Enclosed: $_________ $59.95 - US Funds Cash ( ) Check ( ) Money Order ( ) Make payable to: World Net, Inc. World Net, Inc. |
Mail to: World Net, Inc. |