******************************************************* RAD VIDEO ORDER FORM ******************************************************* We accept Master Card, Visa and American Express. NOTE: This form must be downloaded to your computer, printed out, signed and faxed or mailed back to us at the address or phone number listed at the bottom of the page. ORDER FORM RAD VIDEO, INC. ____________________________________________ Name ____________________________________________ Address ____________________________________________ City State Zip ____________________________________________ E-Mail Address (for notification of special offers and updates) ____________________________________________ Phone # (required for all orders, we will not call unless there is a problem with your payment, and then we will be very discreet) CUSTOMER CERTIFICATION FORM - Signature required for all customers Under penalties of perjury, and as verified by my signature below, I solemnly declare and affirm as follows: I am an adult of at least 21 years of age. I believe in the principles of the First Amendment: free adult citizens have the right to decide what they will read and view in the privacy of their own homes without government intervention or by any person or group. I am ordering this material for myself, for my own private interests and personal use in my private residence. I personally warrant, to the best of my knowledge and belief, that the materials I am requesting contain only descriptions or depictions of sexual activity which are acceptable for adults in my community, based upon the average adult person applying current community standards. I have not asked the U.S. Postal Service to "protect me" from receiving sexually oriented or sexually explicit material. I hereby waive any requirement that an inscription such as "Sexually Oriented Ad" be made on any mail RAD Video sends to me. I have not caused my name to be placed on any list being accumulated by the U.S. Postal Service or any other government agency which forbids my being sent sexually oriented ads through the mails. Further, should my posture in this regard change, I agree to notify you in writing before doing so. I will not sell, rent, or duplicate in any manner whatsoever any material you send me or that I purchase. I understand that such unauthorized use is a violation of U.S. Federal and International Copyright laws. All materials are for my personal use only. I will not exhibit any material you send me to a minor and will insure that no minor has access to it, nor will I expose it to any person whose privacy or sensibilities may be offended. I hereby authorize RAD Video to mail me, from time to time, information, brochures and/or circulars. Signature__________________Phone #(___ )_______Date of Birth_________ By this signature, I agree to the above statements and authorize Rad Video to charge my credit card for this and future orders that I phone in, fax in, or e-mail to Rad Video if I do not include another form of payment. Forms of payment accepted: (Check One) ____Check ____Money Order _____VISA _____MC _____Amex Warning: E-mailing credit card numbers is risky. E-mail can be intercepted. Until better safeguards are in place, we recommend that you return this form by fax or conventional mail. Future orders may be placed by e-mail and we will use the credit card that is on file. After your signature is on file, you may change your credit card information by calling toll-free (800)722-4336. OUR ON-LINE ORDER FORMS ARE SECURE AND MAY BE USED FOR CREDIT CARD TRANSACTIONS. ____________________________________________________ Credit Card Number Expiration Date Money Orders, Visa, Master Card or American Express orders processed the same day we receive it. First time buyers must order by mail or fax and sign the back of this order form. Make checks payable to RAD Video. 15 day hold for all orders paid by check. Prices subject to change and all videos subject to availability. Our Guarantee:If any product you receive fails to perform due to manufacturer's defect, please contact us immediately. We will ship you a replacement, at no cost, with instructions and postage to return the defective video. Returns for any other reason are handled on a case by case basis. All returns must be made within 60 days of purchase. Please email or call us with your request before returning your product. PRICE-----------TITLE------------------------ITEM # __________ ___________________________ _______________ __________ ___________________________ _______________ __________ ___________________________ _______________ __________ ___________________________ _______________ __________ SHIPPING & HANDLING $5.50 for first item, $1.50 for each additional tape (Alaska/Hawaii: $9.50 for first item, $2.00 for each additional item) __________ California Residents add 7.75% sales tax __________ TOTAL CHARGES Today's Date ___________ We currently only ship our adult products to certain destinations within the United States and internationally. Please check with us on our international shipping rates. We currently DO NOT ship to the following locations within the United States: If you live in one of the following areas, you may not enter this site or purchase products from us. * ALABAMA - Prohibited in zip codes beginning with: 366. * FLORIDA - Prohibited in zip codes beginning with: 323 and 325. * KENTUCKY - Prohibited * MINNESOTA - Prohibited in zip codes beginning with 557 and 558. * MONTANA - Prohibited in zip codes beginning with: 591. * NEBRASKA - Prohibited in zip codes beginning with: 681 and 685. * NEW YORK -Prohibited in zip codes beginning with:103. * NORTH CAROLINA - Prohibited in zip codes beginning with 282. * OHIO - Prohibited in zip codes beginning with: 452. * OKLAHOMA - Prohibited * TENNESSEE - Prohibited * UTAH - Prohibited * VIRGINIA - Prohibited in zip codes beginning with 223. RAD Video, Inc. Gay Owned & Operated Established 1989 1947 Fern Street Ste #5 San Diego, CA 92102 (800)722-4336 fax (619)230-0365 email to sales@radvideo.com