***BUY 2 GET 1 FREE SALE***

Purchase any 2 Penis plugs and we will Automatically send you a Free Plug same size.

      

MAIL IN ORDER FORM

ITEM NAME

ITEM SIZE

ITEM PRICE
1    
2    
3    
4    
5    
6    
SUBTOTAL           $
SHIPPING         $                          0.00
TOTAL PRICE           $

PLEASE PRINT OUT FORM - FILL IN THE BLANKS AND SEND TO:

P.P.A.M.          10 GRISHAM CIRCLE          BELLA VISTA, AR 72714

SENDING A PHOTO OF THE ITEM (S) WOULD BE HELPFUL, BUT NOT NECESSARY.

NAME:

PAYMENT TYPE (please circle payment type)
ADDRESS:

CREDIT CARD

MONEY ORDER

CHECK
CITY:

Card Type
STATE:

Card Number:
ZIP CODE: Security code:(3 or 4 digit code on back of card)
PHONE NUMBER: Expiration Date:
E-MAIL ADDRESS:

Signature (Required for Credit Card ):                                                     

  PLEASE ALLOW 10 DAYS FOR CHECKS TO CLEAR PRIOR TO SHIPPING

ALL PAYMENTS MUST BE IN US DOLLARS