ORDER FORM , Wild Bill Video......

Add Title and price--Check......DVD

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LEGAL DISCLAIMER: I the undersigned herby direct WILD BILL VIDEO to mail me all brochures catologs,videotapes. I realize that these items may be considered SEXUALLY EXPLICIT. I DO NOT want the notice Sexually oriented material written on the package or envelope mailed to me. I am an adult 21 years old or older,I am purchasing these sexually oriented material for my private use in my own home. I will not show or sell them to minors. I am not ordering this material as evidence for prosecution. I have not as this date signed U.S.POSTAL FORM 2201(pursuant to 38 usc3010). I believe that this material does not offend the community standards in my ordering area. Make CHECKS OR MONEY ORDERS PAYABLE TO: WILD BILL VIDEO.

MAIL TO: WILD BILL , 3389 Charito Lane , Shingle Springs, CA 95682

SIGNED_______________________

NAME(PRINT)___________________________AGE___________

ADDRESS______________________________________________

CITY__________________________STATE_______________

ZIP CODE___________________ Email______________________

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