CPE SURFACE MAIL ORDER FORM
Print this form or neatly hand-write a copy. 
 

Item __________________________________________________        $___________

Item __________________________________________________        $___________

Item __________________________________________________        $___________

Sub-total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . $___________

California residents add $ 8.25% sales tax . . . . . . . . . . . . . . . . . . . . .$___________

Shipping $5 per order, domestic; $5 per item foreign (includes Canada) $___________

TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .$___________

Please send videotape format (circle one):  DVD

Payment by (circle one): Check/ Money Order

I hereby certify that I am at least 21 years old. I also certify that I am aware that you are sending me
sexually oriented material which is for my own individual use and will not be resold, copied, or in any
way distributed, including to minors.

SIGNATURE: _________________________________________

Send this order form to:
CPE Chelsea Pfeiffer Entertainment
PO Box 6632
Burbank CA 91510
U.S.A.

FIRST CLASS MAIL to:
NAME (please print) ____________________________________

ADDRESS___________________________________________

CITY, STATE__________________________________________

ZIP CODE or POSTAL CODE_____________________________

COUNTRY____________________________________________