MAIL to: Aqua Entertainment, POB 980, Deerfield Beach, FL 33443
                                         or,... FAX to: 954-698-9858

NAME:______________________________________________________________ ____
ADDRESS:__________________________________________________________ _____
CITY:__________________________________ STATE:_____ ZIP:_________________
Email Address:___________________________ PHONE # (opt)____________________

If the mailing address listed above is different from your Visa/Mastercard billing address,
please enter your billing address here. This address will never be used for anything other
than our records but we must have it to verify your card.
* * * No Visa/MC orders will be processed without the proper billing address. * * *

ADDRESS:__________________________________________________________ _____
CITY:______________________________________ STATE:_____ ZIP:_____________

ORDER NO. . . . . . . TAPE TITLE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AMOUNT
__________/ __________________________________________ . . . . . ______________
__________/ __________________________________________ . . . . . ______________
__________/ __________________________________________ . . . . . ______________
__________/ __________________________________________ . . . . . ______________
__________/ __________________________________________ . . . . . ______________
__________/ __________________________________________ . . . . . ______________
__________/ __________________________________________ . . . . . ______________
__________/ __________________________________________ . . . . . ______________

______________________________________________Subtotal . . . . . ______________
_____________________________________minus DISCOUNTS . . . . . ______________
_________________________ Florida residents add 6% sales tax . . . . . . ______________
_____________ *SHIPPING - $4.50 1st item, $1.00 each add'l item . . . . . ______________
((Shipping Overseas - $9.00 1st item, $3.00 @ add'l tape))_TOTAL . . . . ______________

*for shipment to the US and CANADA only - Int'l orders must add sufficient postage.
If you are using Visa/MC/Amex let us calculate the shipping for you. All orders are shipped Priority US Mail
unless otherwise specified

                              LEGAL SIGNATURE
By signing hereunder I certify that I am 21 years of age or older. I am familiar with all local laws in my
area affecting the purchase, sale and shipment of Adult Materials. I have the legal right to purchase and
receive shipment of adult oriented materials and Aqua Entertainment has the legal right to ship them to
me. I guarantee the adult oriented materials I am ordering will not be used for anything other than my
own private enjoyment and will never be shown or given to a minor.

Signature_____________________________________________ Date _______________

Visa/MC# __/__/__/__/ - __/__/__/__/ - __/__/__/__/ - __/__/__/__/ Exp. Date ___/___

CHECKS and MONEY ORDERS payable to: Aqua Entertainment