To order a Bound2bKinky membership or videos by mail, please print this form,
complete the information, enclose your Check, Money Order or Cash payable to:
L J Rowe, and mail it to:

L J Rowe
Suite C
102 Madison Ave.
Waynesboro, PA. 17268.

Please Check Desired Level of Membership :
_____ 1 year $99.95

_____ 60 days (2 months) $32.00
_____ 90 days (3 months) $41.00
_____30 days (1 months) $17.00

Desired:
User Name ___________________
(minimum 6, maximum 12 characters)

Password ____________________
(minimum 6, maximum 12 characters)

Video list

Check the Video you would like and the format

U.S. Customers add $5 per video for shipping and handling and overseas customers add $10 per videofor shipping and handling

Shipping and handling total: __________________

Total Price:________________________________

Read and sign statement:
My signature below certifies that I am an adult, 18 years of age or older, and am lawfully entitled to receive, access and/or view adult materials in the community where I live.   I understand that I am requesting material of an adult nature.   I believe this material to be within the community standards of the area in which I live.   I agree to not duplicate materials I receive or access.   I certify that I will not share this material with, or show this material to, any other persons - especially minors.   I certify under penalty of perjury that all of the aforementioned is true and correct to the best of my knowledge.

Signature______________________________________________________

Print Name______________________________________________________

Date of Birth______________________________________________________

Address__________________________________________________________

City_________________________________________________________

State__________________________________________________________

Zip/Postal Code_________________________________________________

Country Code ___________________________________________________

E-Mail Address _________________________________________________

Once we have received your order, and you check or money order has cleared, we will e-mail you and tell you that your membership has been approved and activated.
No membership or video will be activated until the signed statement above has been received, and your Check or Money Order has cleared our bank.  Then we will email your login ID & Password to you!