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This form is for those that prefer not to use the web for their order, or prefer not to use a credit card. Please remember to include your email address. If there is a problem and I can't get a hold of you, you will not have access to the site. Please remember to choose a username and password. They must be at least 5 characters each in length and cannot be your email address. I will never sell your name or address and I only send out emails if there is a problem with your membership. I will never send out spam emails or share your information with other companies or individuals. Please fill out with large letters as cleanly as possible, so there won't be a delay processing your order. (I have to be able to read it, or it ain't happenin'...) This form must be filled out COMPLETELY and PHYSICALLY signed before it can be processed. I have to have an age statement on file. |
| All field must be completed or your membership will not be processed. |
| Legal Name |
| Address |
| City, State |
| Zip (Postal Code) |
| Country |
| Email Address |
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Requested Username
______________ Password _______________ User name and password must be at least 5 characters long and cannot be your email address. |
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| Twelve (12) weeks $ 62.50 |
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| Fifty-two (52) weeks $ 225.00 | |
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The following statement must be signed or your membership will not be processed. I hereby certify that I am at least 21 years of age, and that I am aware that I am joining a sexually oriented website which is for my own individual use. Material on this site will not be reposted, sold, copied, or in any way distributed, including to minors. |
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Customer Signature |
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Please mail or fax this order to Jim Weathers' Productions |
Fax Orders to: 661-294-5265 Website: http://www.bondagecafe.com Email Inquiries: jweathers@bondagecafe.com |