First Name:_____________________   Last Name:_____________________________________

Street Address:___________________________________________________________________

City:_________________________________   State:_____________   Zip ___________________

E-Mail Address: __________________________________________________
(REQUIRED!  Without an email address, we cannot send you your password!!  Please print clearly!)
 

Preferred Username & Password:   _______________________          ______________________
                                                                                (username)                                             (password)

Payment Option: Cash___   Check___   Money Order___
Note: No international checks, money orders, or bank drafts will be accepted.  Non-US customers must pay by cash or money order from a US bank..
 

Minutes:  _____ 40 minutes for $19.95,      _____ 60 minutes for $29.95,      ______ 120 minutes for $43.95

Make checks payable to "Imago Studios" (no foreign checks or money orders drawn on non-US banks).   REFUNDS ARE NOT OFFERED.

When your account is activated, your username &  password will be sent to the email address you have provided above. Please verify it is correct.

I hereby certify that I am 21 years of age or older and aware that you are sending sexually-oriented material which is for my own individual use and will not be resold, copied, or in any way distributed by me, including to minors.  I further state and agree that this material complies with my local community standards.
 

SIGNATURE_____________________________________ (Required for ALL orders)