DirtyBootyMovies.com order form. Purchase your videos without using your credit card by money order and we can will e-mail you with your login instrustions do download your video files.

Print this form out with your computer. PLEASE PRINT YOUR INFORMATION NEATLY.

DIRECT ORDER FORM
to order by mail, click mouse anywhere on this page, then print this form and mail it to the address below.

Be sure to complete the DECLARATION below and SIGN THE FORM.
ORDER INFO
ITEM 01--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 02--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 03--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 04--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 05--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 06--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 07--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 08--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 09--- Title of the video goes here: ____________________ Price goes here: _________
ITEM 10--- Title of the video goes here: ____________________ Price goes here: _________


TOTAL PURCHASES_______________________________$_________


PAYMENT INFO
CIRCLE PAYMENT TYPE ....check....money order

Please give us your e-mail address just incase we need to get in touch with you incase we have a question on your order. And so we can inform you when your login info has been activated.

E-mail address: ___________________________________ We send NO SPAM or advertisments to your e-mail or shipping address of any kind. So no worries there.

Username:__________________ (max of 8 characters)
Password:___________________(max of 8 characters)

Make Checks payable to:SOUTHBOUND PRODUCTIONS
Send to:
Southbound Productions
1501 South Loop 288
Suite 104 PMB 322
Denton, TX 76205

(SEND COMPLETED ORDER FORM)
DECLARATION (This is a legal document. Read it carefully!)

I hereby swear or affirm, under penalty of perjury, that:
I am currently an adult, at least 21 years of age;
I am voluntarily purchasing these materials because I want to view such materials for my own personal enjoyment and/or education;
I believe that a desire to view sexually explicit materials for enjoyment and/or education is a natural, healthy, and normal part of human behavior;
I understand that the materials I am seeking to acquire are sexually explicit, I am not offended by such materials, it is legal for persons of my age to purchase sexually explicit materials, such as those I seek to purchase, in my community and I will not order, or in any way acquire, materials or goods that would be unlawful to view or possess in my community;
I am familiar with the standards of my community pertaining to the distribution and/or viewing of such materials and the materials I am ordering will not offend the contemporary standards in my community and will not be found by an average member of my community to appeal to a prurient (unhealthy) interest in sex and/or to be patently offensive;
I will not show or distribute the materials to any individual who has not reached the lawful age to view such materials, or who might be offended by such materials;
I am not ordering these materials to use them against any interests of any person or entity; I will indemnify and hold harmless the provider of these materials from any and all civil claims or criminal charges that result from my ordering and/or distributing, in any manner, the materials.

You must complete the blank sections below and sign this form before we can process your order.
I declare under penalty of perjury under the laws of the State of ________________ (your state) and the United States that the foregoing is true and correct, and that this declaration was executed on this date, _________________ (today's date), in the city and state of ___________________ (your city and state).

SIGNATURE: ____________________________________

PRINT YOUR NAME HERE: _________________________

Revised: 5/16/2007

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