JDM Enterprises- LC
51 N 3rd Street #354
Philadelphia, PA 19106
Mail Order
Order Form
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DVD only
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Shipping
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Total
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Postage, Shipping and Handling
Charges are $5.75 for the first Item and .75 cents for each additional
Item
Make Check or Money Order Payable to:
CASH, or leave Blank
CASH Purchases deduct an additional 10% from
the Total
(Note: Cash is green
money, NOT a check or money order)
______________________________________________________________________________
Note: No orders will be shipped without a signature
below!!!
I, the undersigned, hereby
declare under penalty of perjury as follows:
- I am an adult, being
21 years of age or older and I desire to receive sexually oriented material;
that is videos, films, photographs (or copies thereof) containing nudity and
explicit sexual contact between adults.
- I am not an officer
of any law enforcement agency, nor am I an agent of the federal government,
nor am I any way affiliated with the U. S. Postal Service.
- I certify that all
materials received are for my personal use only and I will not resell
materials received from you nor will I exhibit them to a minor or any person
whose privacy may be offended.
- I am not involved
with or will ever be involved in any kind of investigation designed to entrap
participants or producers of materials I am requesting.
- I have not asked the
U. S. Postal Service to protect me from receiving sexually explicit products
or literature. If I no longer desire to received said material I will notify
you in writing for removal and allow 60 days notice.
- I understand that if
I sign a false name or the name of another person to this form I have
committed an act of forgery, punishable by law.
- I understand that
all materials received by me are exempt from U. S. C. 2257 and all codes and
subsections relating to same due to the production date of the materials.
- I certify that the
materials I am requesting does not violate the community standards for
obscenity in the area I am receiving them in.
- I value my right to
privacy and therefore demand that you do not imprint "Sexually Oriented Ad" on
the exterior envelope, or cover as prescribed by section 123.55 of the postal
service manual, 39 C. F. R. Section 124.9(e). That said notice being omitted
is a condition of your doing business with me.
- I expressly make
this declaration to induce you to mail me sexually oriented materials and/or
offers and I understand that you sending me such materials to me is done in
reliance on my promises and representations contained herein.
| Print your
name:
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Your age:
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Today's
date:
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Signature:
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Please print clearly:
| Address:
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| Address:
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| City:
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State:
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Zip:
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| Country:
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Telephone:
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| E-mail address:
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Credit Card Information: Visa, AMEX,
Discover, MasterCard or JCB (Circle One)
Card Number:
____________________________________
Expiration Date: _____________
NOTE: Your charge will appear on your
statement as JDM Enterprises