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Prices are in U.S. dollars.
Name______________________________________
Form of payment_______________Amount________
Age___________Date of birth___________________
By signing this form I declare under perjury of law that I am requesting sexually
explicit
material and am over the age of 18 years (21 in some areas) and it is
legal for me to
purchase and view the material I am ordering.
Signature___________________________________
Remit payment to:
Bummer, Inc.
P.O. Box 343
Allen, Texas 75013
U.S.A.
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