KellyMadison.com - Become a Member by Fax |
If you would like to pay for your membership by credit card via fax, please print out this page and fill in the items. -----Please remember to sign the bottom of this page----- Username __________________ Credit card # ____________________________________ Password __________________ Expiration date___________________________________ First name __________________ CVV2# ________________________________________ Last name _________________________________________________________________ Address ___________________________________________________________________ City _______________________________________________________________________ State______________________________________________________________________ Zip/Postal Code _____________________________________________________________ Country ___________________________________________________________________ Birth date __________________________________________________________________
I declare under the penalty of perjury to the following: I am at least 21 years of age. I will not exhibit this material to any minors. I personally warrant that the material I am requesting is acceptable and meets my community standards. I am not affiliated with any postal or law enforcement agency. I am not placing an order for the purpose of entrapment.
-----put your signature on the bottom of the printed pages----- Cash or MO's are sent next day, personal checks are held for 7 to 10 days to clear. Feel free to e-mail or call once you fax to confirm that your fax has been received.
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