JULIE SIMONE ORDER FORM
(PLEASE PRINT THIS PAGE AND RETURN WITH ORDER)

Money order and cash memberships will be activated upon receipt of payment. If you send a check, it must clear before your membership will be activated.

Be sure to give us a VALID email address so that we can contact you re: your un/pw selection. (Use hotmail or some other free account if you do not want mail to your regular account) Please note your activation date so that you may send in your renewal in time for uninteruppted access.

Membership Options:
1 month membership : $24.00  
3 month membership : $54.00  
6 year membership : $99.00  
Total amount of money enclosed : ________________ (Please remit cash in US Funds ONLY)
Foreign cash will be returned. Cash is mailed at your own risk.

(IMPORTANT BEFORE SENDING CASH, WRAP IT IN A PIECE OF PAPER SO IT IS NOT
VISIBLE FROM OUTSIDE THE LETTER)
PRINT CAREFULLY - If your info is illegible we can't add you to the database.

Username : _____________ (must have letters and numbers, 8 characters or less)
Password : _____________ 

I certify that: I am at least 18 YEARS OF AGE or over and am permitted by law to view adult
materials in my locale (Country , State , Province) and I understand that the contents of JulieSimone.com are of a sexual nature.

___________________________________________________________________________________
YOU MUST SIGN ON THIS LINE OR YOUR MEMBERSHIP WILL NOT BE HONORED !!!
____________________________
TODAY'S DATE

My Name.......:______________________________________
My E-Mail.....:_______________________________________(Please enter a VALID email address)
My Country....:______________________________________
Date of Birth.:________________________________________
State/Province:_______________________________________
Make cheques/money orders payable to 'Julie Simone Productions' and mail to the following address :

Julie Simone Productions
13 W Business Hwy 60
Dexter, MO  63841

Let us know via email when you send so we know to look for it !!!
If you have any questions, please email miss@juliesimone.com
Thank you for your patronage to JulieSimone.com