TREASURE  ISLAND  MEDIA
VIDEO  MAIL-IN  ORDER  FORM
shorter  "fill-in items yourself "  version
Print out this order form and carefully fill it out. Then send it in.

Item  Title

#

Format

Price Each

Total

$       

$         

$       

$         

$       

$         

$       

$         

$       

$         

Sub Total:      

 $

California Residents:
Please add 9.5% sales tax. 

N/A

any

+9.5%

Domestic Shipping:
Fed Ex Ground Rate $8.50

any

N/A

Domestic Shipping:
Fed Ex Standard Overnight $19.95

any

N/A

International Shipping
Fed Ex Int'l Priority $25

any

N/A

Grand Total:    

$

SHIPPING  ADDRESS (Cannot be a P.O. Box)

Name

Street Address

City

State

Country

Zip

Phone

Fax

E-mail

CREDIT  CARD  INFORMATION  FORM
(VISA or MasterCard ONLY)

Name as it appears
on your card:

Account number and CVV2 code from the back of your credit card:

Expiration date:

Billing address
(if different from
shipping address):

Address line 2:

By my signature below, I authorize my credit card's use for the above order. The issuer of the card identified on this item is authorized to pay the amount shown as "Grand Total" upon proper presentation. I promise to pay such "Grand Total" (together with any other charges due thereon) subject to and in accordance with the agreement governing the use of such card.

Signature of
cardholder:

PLEASE  READ  AND  THEN  SIGN  THE  DECLARATION  BELOW.
Video Orders Without Signatures Cannot Be Filled.

By signing below, I swear and affirm that I understand that these videos are pornographic in nature and depict explicitly any or all of the following sexual activities executed between or among consenting adult males: analingus, fellatio, ejaculation, irrumation, kissing, masturbation, nudity, oral contact with sexual and non-sexual body parts, profanity, sodomy, salivary and / or seminal exchange, testicles (oral or manual contact with), urination, urolagnia, verbal abuse, and other sexual activities that may not be specifically listed herein, and are for ADULTS ONLY; I am at least 21 years of age; I am a consenting adult who desires to and legally may view this material; I do not find graphic depictions of the activities listed above or any activities deriving from erotic or sexual attraction or passion distasteful, repugnant or obscene to my sensitivities and, therefore, I freely and so informed waive any right I may have to be protected from "obscene" material by Title 189, United States Code, Sections 1461, 1462, 1463 and 1465, Canada customs memorandum D9-1-1, and any and all other laws of similar nature or intent; I am requesting / purchasing this material for my own personal viewing only and, in my opinion, the videos whose "Item Title/s" I have filled-out in the above form & which are sold by Treasure Island Media meet the community standards of my locality; I am not an employee of, nor being used by, any government agency in purchasing this video to be used against Treasure Island Media, Paul Morris or any other party in any government action or any conceivable manner; I am not associated in any way with any agency of government at any level; and I will not act as informant or appear as a witness in any action taken against Treasure Island Media, Paul Morris, or any other party, in connection with these videos or any other matter, and I understand that purchasing these videos and taking any form of contradictory action would constitute police entrapment, and I will bear responsibility for all legal fees and charges resulting from such action on my part.

Print Your
Legal Name:

Date:

Your
Signature:

Payment is accepted by cash, check, money order, VISA, or MasterCard.  Make checks payable to "Treasure Island Media".  Mail order form with payment to:

Treasure Island Media
2261 Market Street, #435A
San Francisco, CA  94114