BSDLVideo ORDER FORM


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SHIPPING ADDRESS:
Name: 
Address: 
City:   State:   Zip: 
E-Mail Address: 


METHOD OF PAYMENT


REQUIRED LEGAL CERTIFICATION - SALES TO MINORS IS STRICTLY PROHIBITED
I certify by my signature that I am 18 years of age or older and am lawfully entitled to receive sexually explicit materials in the community where I live and through my mailing address. I understand that I am purchasing or requesting materials which are of a sexually oriented nature. I believe this material to be within the community standards of the area in which I live. I further certify that I am not a city, county, or state or federal law enforcement officer, nor am I an inspector or official of the US Postal Service, ordering this material as evidence for the prosecution or harassment of any individual or organization. I further agree not to duplicate or distribute the materials I receive.


SIGNATURE:  _______________________________  DATE: 
(Required)


ITEMS ORDERED (use reverse side if necessary) 

TITLE:   PRICE:   NOTES: 
TITLE:   PRICE:   NOTES: 
TITLE:   PRICE:   NOTES: 
TITLE:   PRICE:   NOTES: 
TITLE:   PRICE:   NOTES: 
TITLE:   PRICE:   NOTES: 
 TOTAL: 

* FREE SHIPPING AND HANDLING
Mail to: BSDLVideo, P.O.Box 613, White Marsh, MD 21162