AMVC.com    --    Mail In DVD Order Form

DVD ID and Title                             Check Web Site For Pricing

DVD-R

DVD+R

1

2

3

4

5

Visa / Mastercard

Merchandise (Total PRICE for all DVDs ordered):

A

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Discount

Enter Discount

B

Money Order

Coupon --->

Amount ----->

Pay To: On The Edge of Cyberspace

State of Washington Add 9% Sales Tax:

C

Toll Free: 1-877-861-6951

Mail Completed Form & Payment to:

USA Shipping = $5 + 50¢ Per Additional DVD

D

On The Edge of Cyberspace, Inc

International Shipping = USA Shipping + $5.00

1509 E. Madison Street, Suite 101

Total Cost For This Order:  A - B + C + D

Seattle, WA 98122

Credit Card Number:

Expire

Name on Credit Card:

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Statement of Intent: I am an adult, aged 18 years or older. I wish to receive the adult erotic material indicated on this

order form. I am purchasing this material for my personal and private use: not for resale, not for rental and not for

display to minors.

All orders must be signed. Unsigned orders will be refused.

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