I certify that I am over 21 years of age, and that it is legal for me to purchase XXX tapes or DVDs in the state or country in which I live.
PRINTED NAME _________________________________________
SIGNATURE_____________________________________________
MAILING ADDRESS______________________________________
APT OR PO BOX (IF NEEDED)_____________________________
CITY, STATE AND ZIP CODE______________________________
Include your email address if you want to be notified when your order was shipped_____________________________
PRINT THIS FORM AND SEND IT WITH YOUR ORDER. SEND CHECK, CASH, OR MONEY ORDER.
Make Check out to HC Website, LLC
Mail the completed Order Form to Mary Hubay, 6912 Bison Circle, Las Vegas, NV 89145. Questions? Call 702-325-4935
I wish to order the following tapes or DVDs. Unless stated otherwise, all movies are in DVD format.
Title: ________________ Number ____ Cost $____ Title: ________________ Number ____ Cost $____
Title: ________________ Number ____ Cost $____ Title: ________________ Number ____ Cost $____
Title: ________________ Number ____ Cost $____ Title: ________________ Number ____ Cost $____
Title: ________________ Number ____ Cost $____ Title: ________________ Number ____ Cost $____
Title: ________________ Number ____ Cost $____ Title: ________________ Number ____ Cost $____
Title: ________________ Number ____ Cost $____ Title: ________________ Number ____ Cost $____
TOTAL COST $ ____
All orders are shipped in plain brown mailers by First Class Mail.