Mail-In Membership Instructions

Simply print out this page and fill out the requested information below and you become a
member of this site. IT'S THAT EASY!!!

International Members Are Welcome!
 
We will e-mail you your membership confirmation,
username and password as soon as we receive this printed signed form and payment.


Print out this form and complete. Please print clearly!
 
The information you provide us is strictly confidential
_________________________________________________________________________________

Bronx Ties Mail Order Form

To order BronxTies membership by money order or check please make your check payable to Fitness House, complete the following information, and mail to:
(this form can be printed or you can provide the information any way you wish. No membership will be activated until the signed statement below has been received)

Fitness House Productions
PO Box 501
Astoria, Oregon 97103

Please Check Desired Level of Membership :
_____ 60 days $39.95
_____ 30 days $19.95

Desired:
User Name ___________________
Password _____________________

Read and sign statement:
My signature below certifies that I am an adult, 18 years of age or older, and am lawfully entitled to receive, access and/or view adult materials in the community where I live. I understand that I am requesting material of an adult nature. I believe this material to be within the community standards of the area in which I live. I agree to not duplicate materials I receive or access. I certify that I will not share this material with, or show this material to, any other persons. I certify under penalty of perjury that all of the aforementioned is true and correct to the best of my knowledge.

Signature____________________________________________________________

Print: Name__________________________________________________________

E-Mail Address ______________________________________________________

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