MAIL ORDER / FAX ORDER FORM
1 Print this completed form and send by 24-hour fax: 1-718-403-0608,
or
2. Mail to: High Drive Productions, 532 La Guardia Place #536, New York, NY
10012
WARNING: WE WILL NOT BE ABLE TO SHIP YOUR ORDER WITH OUT THIS STATEMENT!
CUSTOMER RELEASE STATEMENT
I declare by signing this statement that I am 21 years of
age or older. I also desire to receive sexually-oriented material for my personal
use and authorize you to mail me such material. I have not requested the Postal
Authorities or anyone else to protect me against the receipt of sexually-oriented
materials. These materials will not be shown to minors and I believe they
do not offend the standards of the community in which I live. I am not a Postal
Inspector, a Law Enforcement Official or acting as an agent, attempting to
obtain evidence for the prosecution of any individual or business. All of
the above is understood and true.
Name:
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
E-Mail Address:
Evening Phone:
Signature: _______________________________________________
Date: __________________
TITLE--------------------------- PRICE
1.
2.
3.
4.
5.
SUBTOTAL
TAX (NY Residents include 8.625%)
FREE SHIPPING IN USA ( ADD $5 FOR INTERNATIONAL)
TOTAL
PAYMENT INFORMATION:
WE ACCEPT CHECK/MONEY ORDER & VISA/MASTERCARD
VISA/ MASTERCARD EXPIRATION DATE CCV (3 digit code)
Your credit card statement will show the charge made by Highdrive Productions, Inc
SHIPPING INFORMATION (only if different from the above address)
Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
If you have any questions about your order, please e-mail us at
sales@spunkstar.com.