West Coast Media Group |
NAME ________________________________________________ |
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| Shipping
Fee: US - Priority Mail - $4.95 per order US ONLYl CA Residents Add 8.75% sales tax: TOTAL_________________ |
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PAYMENT OPTIONS: check one ____Cash ____Money Order ____Check ____Visa ____Mastercard |
ACCOUNT
NUMBER______________________________ EXP DATE__________
CW2 NUMBER (3 digit number on back of card) ________
Checks payable to "West Coast Media Group, Inc.". Charges appear on your statement as "West Coast Media Group, Inc."
Credit Cards will be charge immediately for video/DVD orders and all orders will be shipped the same day or
next business day if ordered on a weekend.
All images and content in the site are copyrighted and may not be redistributed
or used in
any way without the expressed written permission of West Coast Media Group Inc.
I hereby certify that I am 18 years of
age or older and aware that you are sending sexually-oriented material
which is for my own
individual use and will not be resold, copied, or in any way distributed by me, including
to minors.
I further state and agree that this material complies with my local
community standards.
SIGNATURE___________________________________________
Date___________ (Required
for ALL orders)