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Print this form out with your computer. PLEASE PRINT YOUR INFORMATION NEATLY. ORDERS ARE SHIPPED THE SAME DAY FORM IS RECIEVED.
DIRECT ORDER FORM
to order by mail, click mouse anywhere on this page, then print this form and
mail it or fax it completed to the address below.
Be sure to complete the DECLARATION below and SIGN THE FORM.
ORDER INFO
ITEM 1_______________________ORDER #___________
ITEM 2_______________________ORDER #___________
ITEM 3_______________________ORDER #___________
ITEM 4_______________________ORDER #___________
ITEM 5_______________________ORDER #___________
ITEM 6_______________________ORDER #___________
ITEM 7_______________________ORDER #___________
TOTAL PURCHASES_______________________________$_________
Texas Residents add 8.25%sales tax __________________$_________
United States shipping charge: 9.00
International Shipping Charge: 1 to 4 items $15.00, 5 or more $20.00_______$_________
TOTAL AMOUNT OF ORDER_______________________$__________
SHIPPING ADDRESS
NAME_____________________________________________
ADDRESS__________________________________________
CITY_______________________ST_______ZIP___________
COUNRTY______________________
PAYMENT INFO
CIRCLE PAYMENT TYPE ....check....money order
Please give us your e-mail address just incase we need to get in touch with you incase we have a question on your order.
E-mail address: ___________________________________ We send NO SPAM or advertisments to your e-mail or shipping address of any kind. So no worries there.
Make Checks payable to:SOUTHBOUND PRODUCTIONS
Send to:
Southbound Productions
1501 South Loop 288
Suite 104 PMB 322
Denton, TX 76205
ORDER BY FAX: (XXX) XXX-XXXX (SEND COMPLETED ORDER FORM)
DECLARATION (This is a legal document. Read it carefully!)
I hereby swear or affirm, under penalty of perjury, that:
I am currently an adult, at least 21 years of age;
I am voluntarily purchasing these materials because I want to view such materials
for my own personal enjoyment and/or education;
I believe that a desire to view sexually explicit materials for enjoyment and/or
education is a natural, healthy, and normal part of human behavior;
I understand that the materials I am seeking to acquire are sexually explicit,
I am not offended by such materials, it is legal for persons of my age to purchase
sexually explicit materials, such as those I seek to purchase, in my community
and I will not order, or in any way acquire, materials or goods that would be
unlawful to view or possess in my community;
I am familiar with the standards of my community pertaining to the distribution
and/or viewing of such materials and the materials I am ordering will not offend
the contemporary standards in my community and will not be found by an average
member of my community to appeal to a prurient (unhealthy) interest in sex and/or
to be patently offensive;
I will not show or distribute the materials to any individual who has not reached
the lawful age to view such materials, or who might be offended by such materials;
I am not ordering these materials to use them against any interests of any person
or entity; I will indemnify and hold harmless the provider of these materials
from any and all civil claims or criminal charges that result from my ordering
and/or distributing, in any manner, the materials.
You must complete the blank sections below and sign this form before we can
process your order.
I declare under penalty of perjury under the laws of the State of ________________
(your state) and the United States that the foregoing is true and correct, and
that this declaration was executed on this date, _________________ (today's
date), in the city and state of ___________________ (your city and state).
SIGNATURE: ____________________________________
PRINT YOUR NAME HERE: _________________________
Revised: 5/16/2007