Check one:
_____ $ 14.95 one month (30 days) Jan In Action
_____ $ 38.95 three months (90 days) Jan In Action
What user name and password would you like to use: (Please print)
User name: ________________________________
Passsword: ________________________________
E-Mail address: ___________________________________________
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Print this form and fill it out and mail to:
Jan B. P. O. Box 20213 Indianapolis, IN 46220 |
Must DATE & SIGN and send with your payment:
I certify that by my signature that I am at least 21 years of age that I wish to order photos, videos and/or materials for my own use in my home. I realize by law that I may not copy, publish, resell or trade these materials said for private use. I also realize that I am not buying any copyrights to these materials. I further certify that I am not a city, county, state or federal law enforcement officer, nor am I an inspector or official of US Postal Service ordering this material with the intention of using said material as evidence for prosecution or harassment of any individual or organization.| Print your name: | Your age: | Today's date: |
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Signature: |
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