Order Form

Print out this form and send to purchase videos

 

Send Money Order To  :
L. Pickett
West Farms Station,
PO Box 726,
Bronx NY 10460

 

Order From:  Name__________________________________________ Date________

Address________________________________________________________________

City______________ State________  Zip Code________________________________

Email__________________________________________________________________

 

Certification of Age:

I am at least over 18 years of age and permitted to receive sexually oriented materials in my locality. 
I hereby authorize
Lorelle Pickett to mail them to me.  (We are NOT responsible for orders detained by authorities
and will NOT reship them at no charge.)

 

Date________________Birthdate________________
Signature__________________________________________________

 

Quantity

Description

Item Price

Item Total

 

 

$

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Merchandise

$

 

Plus Shipping & Handling ($5.00 for US Orders, $15.00 for International

$

 

TOTAL

$

 

 

How did you first hear of Bustybabydollsvideos.com?________________________________________