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JULIE SIMONE ORDER FORM
(PLEASE PRINT THIS PAGE AND RETURN WITH ORDER)
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, or 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 also guarantees that I have not, as of this date, signed
the 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.
Signature__________________________________________________________________
ORDERS WILL NOT BE FULFILLED WITHOUT YOUR SIGNATURE ABOVE
NAME____________________________________________________________________
ADDRESS_________________________________________________________________
CITY________________________State/Province
_______Zip/Postal___________________
EMAIL ADDRESS___________________________________________
(FOR ORDER CONFIRMATION)
LIST Items you wish to by below in the following format:
eg:
DVD - The Jogger QUANTITY
1 PRICE $29.00
POSTER - Julie Simone Vicious, Glamourous QUANTITY
1 PRICE $14.00
1) _______________________________________ QUANTITY ________ PRICE
_______
2) _______________________________________ QUANTITY ________ PRICE
_______
3) _______________________________________ QUANTITY ________ PRICE
_______
4) _______________________________________ QUANTITY ________ PRICE
_______
If you need more room. Please print this page out again !
YOUR
TOTAL
_________________________
US SHIPPING & HANDLING IS INCLUDED
Make check or money order payable to: Julie Simone Productions.
MAIL YOUR ORDER FORM,
MONEY ORDERS, CASH OR CHECKS HERE:
Julie Simone Productions
13 W Business Hwy 60
Dexter, MO 63841
Thank you for your order
Money orders and cash get the fastest turn around time for delivery.
© 2000-2008 Julie Simone Productions. All rights reserved.
All performers in the videos listed are 18 years of age or older.
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