ORDER FORM   

MotoXGirl's Custom Videos

Please print this form below and send via payment for any custom order that you have.

Disclaimer and Order Form

DISCLAIMER

I certify that I am over 18/21 years of age or older,

(whichever is legal adult in your place of residence).

That I am aware that the material I am purchasing is sexual in nature,

and is not to be viewed by minors,

That the materials purchased are to be viewed by me for my own personal use, that I will not show any of the material to children, minors or persons under the age of 18.

It is legal in my state/community for me to have this type of material.

I understand that this video is protected by copyright laws and that any duplication is unlawful.

That none of this material will be duplicated for any reason of any kind.  I agree that if for ANY reason duplicate copies are traced back to me,

I AGREE to pay all Lawyer fees, detective fees, and will face criminal charges and be sued to the fullest extent of the law.

Signed:_______________________

First Name:__________________

Middle Name:_________________

Last Name:_____________________

DOB:________________

Your Address:________________________________________

Shipping Address if Different From Above:___________________________

Email Address:_________________________

Any other custom purchases please list info below: