? Mail Order Form For Porn Videos From AMVC
  
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
Discover  
Check / Money Order   Discount      Enter Discount B
Cash   Coupon --->    Amount ----->
Pay To: On The Edge of Cyberspace State of Washington Add 9.5% Sales Tax: C
Phone: 1-206-860-4239
Mail Completed Form and Payment to: USA Shipping = $5.00 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:                        
   
Credit Card Billing Address:                        
   
City, State, Zip Code:                        
   
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.
   
   
Signed: