*** Please print out this form & mail with your Money Order ***
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NO PERSONAL CHECKS ACCEPTED
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| Under current US law we must have you complete the following form and submit a copy of an official ID showing your date of birth before we can accept any form of payment other than credit and debit cards. We are sorry for the inconvenience but we believe in following legal guidelines. You only need to submit the ID once. |
| THE TERMS OF THIS LEGAL CONTRACT |
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1.I am at least 18-21 years of age which ever is the legal definition of adult
in your jurisdiction. |
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Please check if this is your first Mail Order BeckyButt.com. ______ |
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If this is a repeat order you do NOT need to enclose ID a second time. |
| NO PERSONAL CHECKS ACCEPTED NO PERSONAL CHECKS ACCEPTED |
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Product description |
Subscription to BeckyButt.com |
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| Circle Your Choice of Subscription Below | |||||||
| $15.00 Three Month Subscription or $25.00 Six Month Subscription | |||||||
| $45.00 1 Year Subscription or $60.00 1 Year Subscription plus get a PlumpVideo.com Preview DVD | |||||||
| * You'll be notified by email with your login information once we receive payment * | |||||||
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Your Information |
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Please Print Clearly Please Print Clearly Please Print Clearly Please Print Clearly Please Print Clearly |
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| First name | ___________________________ |
| Last name | ___________________________ |
| E-mail ( Very Important ) * | ___________________________ |
| Address | ___________________________ |
| City | ___________________________ |
| State | ___________________________ |
| Zip code | ___________________________ |
| Telephone (Ex: 555-555-5555) | ___________________________ |
| Money Order Amount | $__________________________ |
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Your Username & Password will be assigned to you |
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This may take a few days depending on when we receive payment by mail. You'll be notified via email when received. |
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Any Questions Contact: mo@beckybutt.com |
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