Sara Jay Videos :: Mail order

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Mail order

Please fill out this form, and mail it along with a money order, cash or cashier's check (payable to SWP Inc ). No personal checks! Mail to:

SWP Inc

Attn: Sara Jay

247 SW 8th Street, Suite #220, Miami, Florida, USA 33130

Write down the titles of the videos you would like to order and if you would like DVD or VHS format. If ordering more than one video, add shipping to the total order, not individual videos. For our video specials, indicate which special and titles you would like, put the price of the special in the area marked "Sub Total" then add shipping costs.

VIDEO TITLE

VHS OR DVD

PRICE

TOTAL

___________________________________________________________________________________

SUB TOTAL :$ ____________

SHIPPING OPTIONS :	USPS Priority Mail 6.50 (U.S. ONLY)	$___________
	International 15.00	$___________

GRAND TOTAL: $____________

Today's date ________________________________________________________

Name _____________________________________________________________

Shipping address ____________________________________________________

City _______________________________________________________________

State and zip code __________________________________________________

Email address ______________________________________________________

Signature __________________________________________________________

Your age ___________________________________________________________

Telephone number ___________________________________________________

Would you like to be on our email update list? Yes_____ No _____

LEGAL DISCLAIMER: I certify that I am over 21 years of age and that I wish to order the merchandise indicated for my own use at home. I further certify that I am not a city, county, state or federal law enforcement officer, nor am I an inspector or official of the US Postal Service, ordering this material as evidence for the prosecution or harassment of any individual or organization. My signature above also guarantees that I have not, as of this date signed US Postal form 2201 (pursuant to 38 USC 3010) and I hereby warrant that I have no intention of signing said form in the future.

THANK YOU FOR YOUR ORDER!

U.S.C. 2257 Record-Keeping Requirements Compliance Statement.