PROOF OF AGE SECTION

1)  Our records will stand as proof of your age and agreement to our terms. You must be 21 or over to be put on our mailing list. NO EXCEPTIONS!

2)  This required information is our Merchant Services Agreement for accepting Internet, Phone, Mail or Fax transactions for your purchase or the sending of brochures.
3) Do you certify that you are at least 21 years of age and a consenting adult who is requesting to be put on our mail list? YES NO
Sorry, if you answer "NO" we cannot continue this transaction.
4)  Please enter your date of birth :  Month / Day / Year

5) Please enter your name

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

6) Please enter Email address here:

YOUR FULL LEGAL NAME FOR THIS AGREEMENT


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