VIDEOSTORE: "BISEXUAL NATION" ORDER FORM

SECTION 1: CREDIT CARD TERMS & PROOF OF AGE SECTION

1) This form will stand as proof of your age and an agreement to our terms. PURCHASERS OF VIDEOS MUST BE AT LEAST 21 YEARS OF AGE! NO EXCEPTIONS!

2) Required information as per our Merchant Services Agreement for accepting Internet, Phone, Mail or Fax transactions for your purchase.

3) Do you certify that you are at least 21 years of age and a consenting adult who is requesting to purchase videos for your own personal use and "NO" other purpose? YESNO
SORRY, IF YOU ANSWER "NO" YOU MUST STOP HERE AND CAN NOT COMPLETE THIS ORDER FORM.

4) Please enter your date of birth which is Required Information:
Month / Day / Year

5) Have you read, understand and agree to SEXSITE'S TERMS for the sale of Adult videos and do you agree to and certify to abide by these TERMS and CONDITIONS? YESNO

SECTION 2: ONLINE CREDIT CARD SECTION

Cards accepted are:

We verify all Credit Card Information for your protection as well as our own.

1) Please enter your FULL NAME exactly as it appears on your credit card :

2) Please enter your Credit Card BILLING ADDRESS where you receive your monthly bill .
THIS IS VERY IMPORTANT for the following reasons:

a) It will be verified for an approval on your Card;
b) It will be matched to your card when processed;
c) Your video purchase will be mailed to the address

ADDRESS: APT #
CITY: STATE or PROV:
COUNTRY: ZIP or POSTAL CODE:

3) Please enter Email address here:

YOUR E-MAIL ADDRESS IS IMPORTANT TO COMPLETE ORDER FOR SHIPPING PURPOSES

4) PLEASE ENTER YOUR CREDIT CARD INFORMATION:

5) CREDIT CARD NUMBER:EXP. DATE:

PLEASE NOTICE THAT ALL VIDEOS ARE IN AMERICAN STANDARDS,
A NTSE PLATFORM & VHS FORMAT ONLY!

5) You are selecting "BISEXUAL NATION" in STEREO and running time 120 minutes:
PRICE: $59.95USD

6) SHIPPING & HANDLING CHARGES WILL BE ADDED AS FOLLOWS:

7) ENTER THE TOTAL AMOUNT OF YOUR ORDER HERE: $USD

PLEASE NOTE THAT CHARGES TO YOUR CREDIT CARD WILL READ THOR PRODUCTIONS ON YOUR CC STATEMENTS. ALL MAILED VIDEO PACKAGES ARE SHIPPED BY UPS OR U.S. MAIL. By submitting this form you are giving us authorization to charge your Credit Card for the cost of the video you selected above. Your order will be processed and mailed (by US GLOBAL PRIORITY mail for outside the USA)within 7-10 working days from your order. For orders to countries outside the USA, all purchases are at YOUR OWN RISK. We make every attempt to deliver your order to you. If confiscated by Customs, we DO NOT REFUND, REPLACE OR REPLACE FOR FREE your video that has been sent.

YOUR FULL LEGAL NAME FOR THIS AGREEMENT