Mail order subscription form for site membership -  1 year for 249.95

Print this form and fill it out completely. Include your email address so I can notify you of when your subscription begins. 

Fax to: 412 441 6311  or    Phone: 412 362 6883 (Have your CC ready)    or mail to: MIB POB 42430 Pittsburgh PA 15203 USA

I will be determining your username and password, and emailing you log in instructions.

Your credit card statement will appear MIB Productions

Full name:

Address:

City, State, Country, Postal code:

 

Email address:

Phone number:

I may need to call you to ensure that your card is not being used fraudulently (make sure that you are the card holder), so be near the phone to speak with me if I need to do that.

WEBSITE IS FOR VIEWING BY LEGAL ADULTS ONLY

I am over 18 years of age. This is adult material with bondage and discipline themes. I am aware of my local laws and am taking full liability for website contents.

Signature:                                                                                           Date:

Subscriptions Available By Mail:

Payment method: Check , Money Order or

CC _____ _____ _____ _____ exp. date:_____ _____

The 3 security code on the back of your credit card:_________

The address for your credit card:

 

 

Fax to: 412 441 6311          or mail to: MIB POB 42430 Pittsburgh PA 15203 USA