I, the undersigned, hereby declare under the penalty of perjury as follows: I am an adult person over the age of 18 years. I am purchasing sexually oriented material for private use in my home. I understand this material cannot be used for resale or any other commercial dissemination, or broadcast including trade; I will not furnish this material to minors. I further certify that I am not a city, county, state, or federal employee, nor am I an employee of the U.S. Postal Service or anti-smoking or public health organization ordering this material with the intention of using such material as evidence for the prosecution or harassment of any individual or organization. I wish all material sent by you to be mailed in plain wrapping. I do not wish the words "sexually oriented material" to be printed on the exterior. I believe the United States Constitution guarantees freedom of expression and protects the right of privacy for the individual. I believe the material I am ordering does not offend the standards of my community.
Signature___________________________________ Date_____________________
Print Name for shipping purposes ________________________________________________
Address___________________________________________
City___________________ State/Province____________________
Zip/Postal Code___________________ Country_________________
SAFE Telephone in case of e-mail bounce. _________________________
RELIABLE E-mail Address!!_________________________________
NOTE: DVDs designated as REGION #1 are US Format NTSC and may not play reliably
on European or other Non-United States type DVD players. (See video order page
for REGION #1 type DVDs.
Region #0 discs are playable Inside AND Outside the US.
Not Accepting new VHS Orders at this time
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Subtotal_______________________
Shipping minimum $5.00_______________________ Click
here for shipping info
Total__________________________
Payment by Money Order or Cashiers Check MUST BE DRAWN ON A BANK WITH UNITED STATES BANK ROUTING NUMBERS! European Money Orders or Cashiers checks must have US bank routing numbers.
Credit card number________________________________ Expiration date__________________
C V V 2 or 3 digit Security Code number on the back of your card (REQUIRED)________
NAME AS PRINTED ON CREDIT CARD_________________________________________
REQUIRED: Billing Address if different from Shipping Address
Address ________________________________
Address_________________________________
City_____________________ State/Province___________________
Zip/Postal Code_________________ Country___________________
Voice number 405 525-8001(1 PM to 7 PM Central Time - US) E-Mail: clp05ed@theshop.net
Address: CLP, PMB 255, 6608 N. Western Avenue, Oklahoma City, OK 73116