Please print out this form, sign it and return it to us by:
FAX: (415) 252-7747
Postal Mail: TITAN MEDIA - PO Box 411345, San Francisco, CA,
94141-1345
Federal Law requires that you have a valid signature statement on file with us before your order can be shipped. Once your signature statement is on file with us future orders can be ordered and shipped with no delay period.
You may also use this form to request that a password for our Hardcore Previews area be issued to you.
(International Orders and TitanMen On-Demand memberships DO NOT require this statement)
Orders without a valid signature statement on file cannot be shipped.
NO EXCEPTIONS.
Please check the statement that applies below:
( ) I am submitting this form to allow the shipment of a purchase.
( ) I am submitting this form to get a password for the Hardcore Previews area.
FAX #: (415) 252-7747
By signing below I hereby certify that:: I am an adult, 21 years of age or older. I am requesting and agree to accept sexually explicit material, including explicit direct mail brochures, to be sent to me for my personal use in my private home.
I personally and without coercion will make selections of such material and these products will not violate the community standards of the area in which I live. I will not copy, sell, charge admission for viewing or exhibit these products or brochures to minors or anyone else who might be offended by them.
I have not requested the Post Office Dept. or anyone else to protect me against the receipt of sexually explicit material, nor am I a Postal Inspector or Government Employee requesting these materials in an official capacity.
I declare under penalty of perjury that all above statements are true and correct and hereby authorize TITAN MEDIA to ship me the sexually explicit materials that I order.
I also certify that the purchase of the above products is for home use only and NOT to be RESOLD at retail or for RENTAL purposes. I further recognize that the materials purchased are not to be duplicated for any purpose, as they are copyrighted materials.
Signature:__________________________________________________
Printed Name:_______________________________________________
Email Address:______________________________________________
Telephone Number:___________________________________________