PARADISE VISION ORDER FORM

SHIPPING ADDRESS:

Name: __________________________________________________________________________
Address:__________________________________________________________________________
City: __________________________________ State: __________ Zip:____________
Phone #: ___________________ E-Mail Address: __________________________________
 
METHOD OF PAYMENT    - NO PERSONAL CHECKS PLEASE!       
                ___  Check or money order, payable to Paradise Vision, in U.S. dollars.
             (Only "American Express" money orders accepted for International Orders)
 
                Bill my credit card: ___  Visa  ___  MasterCard  ___  American Express  ___ Discover/Novus
                Card Number  _______________________________ Expiration Date ______________
                         (please record all digits)
 
                CREDIT CARD BILLING ADDRESS  (If Different From Shipping Address)
                IMPORTANT! - This information must be EXACT
                NAME:  _________________________________________________________________
                ADDRESS:  ______________________________________________________________
                CITY:_______________________________  STATE: __________ ZIP:____________
 
REQUIRED LEGAL CERTIFICATION - SALES TO MINORS IS STRICTLY PROHIBITED
I certify by my signature that I am 18 years of age or older and am lawfully entitled to receive sexually explicit materials in the community where I live and through my mailing address. I understand that I am purchasing or requesting materials which are of a sexually oriented nature. I believe this material to be within the community standards of the area in which I live. 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. I further agree not to duplicate or distribute the materials I receive.
 
SIGNATURE_______________________________________________ DATE:__________________
                        (Required)
 
ITEMS ORDERED  (use reverse side if necessary)

TITLE______________________________________   PRICE _____________
TITLE_______________________________________ PRICE _____________
TITLE_______________________________________ PRICE _____________ 
TITLE_______________________________________ PRICE _____________
TITLE_______________________________________ PRICE _____________
TITLE_______________________________________ PRICE _____________ 
TITLE_______________________________________ PRICE _____________
TITLE_______________________________________ PRICE _____________                 

                                                                               
                                                                          SUBTOTAL  _____________
                                      California residents add 7.75% TAX  _____________
                                                     SHIPPING & HANDLING *  _____________

                                                     IF ORDER BEFORE SHIPPING IS OVER $100
                                                    
DEDUCT 10%  HERE      -  _____________
 
                                                                              TOTAL  _____________
 

* SHIPPING AND HANDLING
U.S. Orders:  $10
U.S. Overnight:  $30
International/Overseas:  $15

Mail to:  Paradise Vision,  11956 Bernardo Plaza Dr.., #312, San Diego, CA 92128
Call :     Toll-Free 24 hour Order Line (888) 755-3338