Please print out this form, fill it out completely and neatly.  Attach a money order or cashiers check.

Sorry but no personal checks will be accepted, all monies must be in certified US Dollars.

Please make the money order or cashier's check payable to Ashley Evans

• Please provide the following contact information:

  Name
  Street Address
  Address (cont.)
  City
  State/Province
  Zip/Postal Code
  E-mail
  MAKE SURE YOUR EMAIL ADDRESS IS LEGIBLE I must be able to read your email address to contact you when the funds are received

• Please provide the following ordering information:

  _ One month for $19.00 U.S. Dollars

  _ Two Months for $38.00 U.S. Dollars 

  Please certify that you are over the legal age in your area of residence and can view images and text of the adult nature meant for mature and adult audiences.

  I certify that I am of legal age in my area of residence to view images and text meant for a mature and adult audience.
  
  Signed: __________________  Age: ______     Date: __________________
  

You will be notified by e-mail as soon as your account is activated.

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