This letter is to certify that I

This letter is to certify that I _________________________(please print) under penalty of perjury, declare and affirm that I am over 18 years of age and that it is legal for me to purchase the materials requested.
Title: DVD / VHS ___________________________ price_________________

I also state that I ______________________ am not an agent nor employee, nor work for in any capacity, nor are employed by any local, city, county, state, government or federal agency. Nor am I ordering or trading for these materials for the purpose of entrapment or any sort of legal prosecution.

I _____________________ also state that it is legal for me to purchase and have sent to me the adult materials requested, and that it is not illegal in the town, township, city, county, state or province where I reside or having this mailed to.

I _______________________am not purchasing/ trading/ acquiring this material to use against the seller/ trader/provider or any other person whatsoever in any conceivable manner.

I_____________________ will not permit any minor, or other person who might find such material offensive to view or have access to this material.

I ____________________ fully understand that I am requesting sexually oriented materials. I further state that I am requesting these materials for my own private use and will not trade/ sell these materials to other parties. I am not affiliated with any nationwide distribution company or business of any sort.

Please Sign: _________________________

Date:_____________

Date of Birth:_____________

Ship To: (Please Print)

________________________________________

Circle DVD / VHS Title:____________________________________________ price_________

Be Sure to include shipping...$5.95 for US .... $9.95 for Canada ... $15.00 all other.