Print out and mail in this form to (money order or cash)

Triple sSs Publishing

P.O. Box 1075

Lancaster, OH 43130

1. ) By signing and sending in this form along with your payment and Valid ID you are affirming that you are at least 18 years of age and that it is legal in your area to view sites that contain adult content in your area. You must send in a Valid Photo ID showing your age, and completely fill out the form below.

YOU MUST submit a photo copy of your ID showing your face and Date of Birth. You can mark out your other identifying data, we just need to prove your age. Use your digital camera, take a picture of your ID, that will work too.

Printed Name: ______________________________ Date of Birth: ________________________

Signature: _________________________________ Date: ________________________________

Name of the girl you are signing up for (web site address): ______________________________

(circle the membership type you are signing up for below)

30 days: $14.95

90 days: $25.00

180 days: $45.00

User name requested: ________________________

Password requested: _________________________

Your Email address: (NO @aol.com email addresses) __________________________

We can't email you confirmation that you are all set if you don't give us a valid email address. AOL likes to bounce any email with site information in it.