Big Butt Farm ORDER FORM

TITLE--Please check DVD or VHS------------------------------------------------

#1_________________________________$ ________DVD____VHS_____

#2_________________________________$_________DVD____VHS_____

#3_________________________________$_________DVD____VHS_____

#4_________________________________$_________DVD____VHS_____

___________________________________Shipping___________

______________________________________Total___________


LEGAL DISCLAIMER: I the undersigned herby direct WILD BILL VIDEO to mail me all brochures catologs,videotapes. I realize that these items may be considered SEXUALLY EXPLICIT. I DO NOT want the notice Sexually oriented material written on the package or envelope mailed to me. I am an adult 21 years old or older,I am purchasing these sexually oriented material for my private use in my own home. I will not show or sell them to minors. I am not ordering this material as evidence for prosecution. I have not as this date signed U.S.POSTAL FORM 2201(pursuant to 38 usc3010). I believe that this material does not offend the community standards in my ordering area. Make CHECKS OR MONEY ORDERS PAYABLE TO: WILD BILL VIDEO.MAIL TO:WILD BILL ,PMB #308 ,3450 PALMER Drive # 4 , Shingle Springs, CA 95682

SIGNED_______________________

NAME(PRINT)___________________________AGE___________

ADDRESS______________________________________________

CITY__________________________STATE_______________

ZIP CODE_____________________PHONE

Email______________________

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