JULIE SIMONE ORDER FORM

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.