Gloryhole Swallow Membership Mail Order Form

 

Please complete this form and send it along with your "Cash" or "Money Order" to:

CP Productions Inc.

14747 N. Northsight Blvd.
Suite 111-170
Scottsdale, AZ 85260

 

IMPORTANT:

I declare under the penalty of perjury to the following:

1)  I am at least 18 years of age.

2)  I will not exhibit this material minors.

3)  I personally warrant that the material I am requesting is acceptable and meets my community standards.

 

Signature:

 

Full Name:

 

Email:

 

Username:  
Password:  

For increased security Username and Password must be 8-16 characters and should be a combination of UPPER/lower case letters including numbers and special characters.  Avoid using common dictionary words.

 

Membership Term

___ 1 Month = $30 USD        ___ 3 Months = $80 USD        ___ 6 Months = $150 USD       ___ 12 Months = $250 USD

 

NOTE: I will send you an email letting you know when I received this completed form with payment.  

Thanks for joining my site...enjoy!

Rev. 2014-08-16