Suzys Secrets

Cash Membership Order Form

(Print this Page and send in)

 

Name: _____________________________________________________
(first) (middle initial) (last)


Address:_____________________________________________________
(street number)

_____________________________________________________
(city) (state) (zip code)

Date of birth: _____/_____/_____ Phone: (_____)________-________

E-Mail Address: _____________________________________________

Subscrition lenghth desired:

1 Month membership________$7.99( CASH ONLY ) U.S. Dollars

3 Month membership _______ $21.00( CASH ONLY ) U.S. Dollars

 

User Name:________________ ( 4-8 characters )

Password:________________ ( 4-8 character )

Note:

You will be notified by E-mail when your account is activated

Your User Name & Password will be confired in that E-mail they could be different so check them.

This is a nonrefundable Membership after activatived and is non-reoccuring.

 

 

 

Mail To:

Suzy's Secrets

P. O. Box 370035

Milwaukee, WI 53237

 
 

 

I/We declare that I am an adult 18 years of age or older and am lawfully entitled to receive sexual explicit materials in the community, country and/or state where I/We live and through my mailing address. I/We understand that I/We am purchasing/requesting materials to be within the community standards of the area in which I/We live. I/We authorize Suzy’s Secrets to send materials purchased/requested to me at the address above. I/We have not requested the US Postal service or anyone else to protect me against the receipt of sexually oriented materials. I/We am not an agent or employee of the US postal service, any other government agency and/or not an officer of the law, federal, state or local government using correspondence and/or ordering/requesting/buying materials for purpose of entrapment. I have absolutely no desire to purposefully or accidentally receive or request any material considered illegal or obscene. I further agree to not duplicate materials purchased/received for commercial
purposes.


Signature:____________________________________Date:_________________
( Send copy of photo ID with age on it )