GAGFACTOR.COM DIRECT ORDER FORM
to order by mail, click mouse anywhere on this page, then print this form and mail it or fax it completed to the address below.
Be sure to complete the DECLARATION below and SIGN THE FORM.

ORDER INFO
ITEM 1_______________________CATALOG #___________
ITEM 2_______________________CATALOG #___________
ITEM 3_______________________CATALOG #___________
ITEM 4_______________________CATALOG #___________
ITEM 5_______________________CATALOG #___________
ITEM 6_______________________CATALOG #___________
ITEM 7_______________________CATALOG #___________
ITEM 8_______________________CATALOG #___________
ITEM 9_______________________CATALOG #___________
ITEM 10_______________________CATALOG #___________
ITEM 11_______________________CATALOG #___________
ITEM 12_______________________CATALOG #___________
ITEM 13_______________________CATALOG #___________
ITEM 14_______________________CATALOG #___________

ONLY $29.95 each, Order 2 for $49.95, Order 3 or more $19.95 each
Order 5 and get 1 more video of your choice FREE! Order 10 and get 2 more videos of your choice FREE!
TOTAL PURCHASES_______________________________$_________
California Residents add 9.75% sales tax __________________$_________
Domestic Shipping Charge: 1 to 3 items $8.00, 4 or more $11.00_______$_________
International Shipping Charge: 1 to 4 items $35.00, 5 or more $40.00_______$_________
TOTAL AMOUNT OF ORDER_______________________$__________

SHIPPING ADDRESS
NAME_____________________________________________
ADDRESS__________________________________________
CITY_______________________ST_______ZIP___________

PAYMENT INFO
CIRCLE PAYMENT TYPE ....check....money order....visa....mastercard....american express
NAME ON CARD___________________________________________
CARD #_______________________________EXP. DATE___________
SIGNATURE________________________________________________

Make checks payable to JM PRODUCTIONS.

JM PRODUCTIONS
9018 BALBOA BL. PMB# 576
NORTHRIDGE, CA. 91325

ORDER BY FAX: (818) 772-9254 (SEND COMPLETED ORDER FORM)

DECLARATION (This is a legal document. Read it carefully!)
 
I hereby swear or affirm, under penalty of perjury, that:
I am currently an adult, at least 21 years of age;
I am voluntarily purchasing these materials because I want to view such materials for my own personal enjoyment and/or education;
I believe that a desire to view sexually explicit materials for enjoyment and/or education is a natural, healthy, and normal part of human behavior;
I understand that the materials I am seeking to acquire are sexually explicit, I am not offended by such materials, it is legal for persons of my age to purchase sexually explicit materials, such as those I seek to purchase, in my community and I will not order, or in any way acquire, materials or goods that would be unlawful to view or possess in my community;
I am familiar with the standards of my community pertaining to the distribution and/or viewing of such materials and the malerials I am ordering will not offend the contemporary standards in my community and will not be found by an average member of my community to appeal to a prurient (unhealthy) interest in sex and/or to be patently offensive;
I will not show or distribute the materials to any individual who has not reached the lawful age to view such materials, or who might be offended by such materials;
I am not ordering these materials to use them against any interests of any person or entity; I will indemnify and hold harmless the provider of these materials from any and all civil claims or criminal charges that result from my ordering and/or distributing, in any manner, the materials.
 
You must complete the blank sections below and sign this form before we can process your order.
I declare under penalty of perjury under the laws of the State of ________________ (your state) and the United States that the foregoing is true and correct, and that this declaration was executed on this date, _________________ (today's date), in the city and state of ___________________ (your city and state).
 
SIGNATURE: ____________________________________
 
PRINT YOUR NAME HERE: _________________________
 
Revised: 10/31/2003