RadVideo.com
Adult Access Application

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WARNING! Our Adult Acess features contain sexually explicit images and
product descriptions that are intended solely for viewing by adults at least
21 years old who are interested in sexually explicit materials for their
personal information, education, and entertainment in the privacy of their
own homes. Consenting adults who wish to view and/or purchase any sexually
explicit materials that are presented on our website must first register with 
RAD Video. By registering you agree not to utilize any of the text, graphics, 
images or movie previews for commercial purposes of any kind without the 
express written permission of RAD Video. And you further agree not to share 
or distribute these materials in any fashion to minors under age 21.

Before entering our Adult Access features you must first register. It will only 
take a minute. We offer a lifetime registration for only $10.00 which will be 
deducted from your first purchase. We accept international members but only
 ship to locations within the U.S. If you have other questions, please check 
 out our FAQ.

This form must be faxed or return to us by mail. (address and number below)
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By my signature below, I solemnly declare and affirm,under penalty of perjury,
the following is true:

1)  I am at least 21 years of age;
2) I am requesting your materials for my own personal use
  in my private residence;
3)  I will not exhibit any material you send me to a minor
  and will carefully insure that no minor has access to it;
4)  I personally warrant that the materials I am requesting,
  to the best of my knowledge and belief, contain only
  descriptions or depictions of sexual activity which are
  acceptable for adults in my community, based on the average
  adult person applying current community standards;
5)  I authorize RAD Video to bill my credit card for this and
  future purchases that I may submit by phone, fax, online
  or e-mail.
6)  In addition, I understand that Rad Video only ships to
  certain locations. (check on-line for those locations)
7)  I understand and agree that membership fees are non-refundable
  but will be deducted from my first purchase.

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First name	________________________________
Last name	 ________________________________
Mailing Address ____________________________
Street   __________________________________
Apt/Ste #_________ (leave blank if not applicable)
City     __________________________________
State   __________________________________
Zip       __________________________________
Telephone :  _______________________________
(Used only if problems occur with your credit card.)
E-mail  __________________________________

Paymant Information
__Visa   ___Master Card  ___Discover Card 
__American Express ____ Check

Credit Card Number __________________________
Expiration Date - Month____ Year____

Date of Birth ______________ (mm/dd/yy)

Enter a name you will use to access RAD Video's Adult Access features
RAD User Name ______________ (Note: this is case-sensitive,
use letters only)


Signature: ______________________________________

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Copyright © 2003. All Rights Reserved

Fax to 619-230-0365
or send by U.S. Mail

RAD Video, Inc.
1947 Fern Street, Suite 5, San Diego, CA 92110
fax 619-230-0365-or- Toll Free 800-722-4336
e-mail - members@radvideo.com