Jim Weathers' Productions Mail / Fax Subscription Form

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.

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 (If I can't read your order, you won't be able to access the site).

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
Requested Username ______________ Password _______________
User name and password must be at least 7 characters long and cannot be your email address.

Please make checks and money orders payable to: Jim Weathers' Productions
Ninety (90) Day Membership $ 59.95

Check or Money Order
1 Year Membership $ 215.00

DO NOT SEND CASH!

The following statement must be signed or your membership will not be processed.

I hereby certify that I am at least 18 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.
Customer
Signature		 x

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Please mail or fax this order to

Jim Weathers Productions, Inc.
28920 Avenue Penn, #104
Valencia, CA 91355

Website: http://www.bondagecafe.com

Email Inquiries: jweathers@bondagecafe.com