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Suncoast
Please print out the following form, fill it out neatly, attach cash, money order or
check drawn on a US bank only and made payable to Suncoast. |
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Name:____________________________________________________________________ Address:__________________________________________________________________ City, State, Zip:____________________________________________________________ E-mail Address:____________________________________________________________ |
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Item # or Name Quantiy Price Personalization __________________ _______ ________ _____________________________________ __________________ _______ ________ _____________________________________ __________________ _______ ________ _____________________________________ __________________ _______ ________ _____________________________________ __________________ _______ ________ _____________________________________ __________________ _______ ________ _____________________________________ __________________ _______ ________ _____________________________________ TOTAL # OF ITEMS: ____________ TOTAL ENCLOSED: $____________ |
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I by my signature below I hereby certify that I am of legal age in my area
of residence to receive and view products meant for a mature and adult audience
and it is not illegal to order and or receive such material in my community, city,
county or state.
( Back To HotStuff ) |
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| Signed: _____________________________________________ Date:________________________ |
