--    Mail In DVD Order Form
DVD Title                             All Mail Order DVD's Are $19.95/each         # of DVD's Amount
  Merchandise (Total PRICE for all DVDs ordered): A
Check / Money Order   Discount      Enter Discount B
Cash   Coupon --->    Amount ----->
Pay To: AMVC, LLC State of North Carolina Add 7.25% Sales Tax: C
Mail Completed Form and Payment to: USA Shipping = $5.00 D
AMVC, LLC International Shipping = USA Shipping + $5.00
931-B S Main Street #106 Total Cost For This Order:  A - B + C + D  
Kernersville, NC 27284
Telephone Number:                        
Shipping Name:                        
Shipping Street Address:                        
City, State, Zip Code:                        
Email Address:                        
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.