To send us your order, print, fill out, sign & date this form and send to:

By Fax: Fax to (818) 265-0201

By Mail: Mail in with your check or money order (payable to Kick Ass Pictures) to:

Kick Ass Pictures, Inc.
710 Ivy Street
Glendale, CA 91204

We accept checks, money orders and credit cards (Visa, MasterCard, American Express and Discover). Videos & DVDs are sent via Priority Mail in discreet packaging. Although many orders are shipped out the next day, please allow two to three weeks for delivery after we receive your order. If you have any questions, you can fax us at (818) 265-0201, or e-mail us at comments@kickasspictures.com.
(Note: We do not sell the names of our customers to anyone!)

Sorry, but we DO NOT SHIP videos to Alabama, Arkansas, Kentucky, Mississippi, Tennessee, Utah or zip codes in Florida beginning with 323, 324, 325 or 326. Nor do we ship international.

Pricing
Individual videos/DVDs: $29.95 each
Buy three: $24.95 each!
Buy five or more: $19.95 each!!

Please write in the titles below.
TITLE	FORMAT
1. _______________________________________________	DVD
2. _______________________________________________	DVD
3. _______________________________________________	DVD
4. _______________________________________________	DVD
5. _______________________________________________	DVD
6. _______________________________________________	DVD
7. _______________________________________________	DVD
8. _______________________________________________	DVD
9. _______________________________________________	DVD
10. _______________________________________________	DVD
Please use additional sheets if order more than 10 titles.

SUB-TOTAL (Total Number of Videos/DVDs x Price Each)	$__________________
California residents add 8.25% sales tax	$__________________
Video Shipping: $ 8.00 PLEASE NOTE! We no longer accept orders outside the U.S.	$__________________
TOTAL	$__________________

BILLING INFORMATION

Name	____________________________________________
Shipping Address	____________________________________________
	____________________________________________
City	____________________________________________
State	_________________________
Zip Code	_______________________
E-Mail Address	__________________________________
Payment Method (circle one) VISA | MASTERCARD | DISCOVER | AMERICAN EXPRESS | CHECK | MONEY ORDER Credit Card Information Number: _______ - _______ - _______ - _______ EXP (MONTH/YEAR): ________ / ________
Credit Card Billing Address (if different than shipping)
Street Address	_________________________________
Zip Code	_________________________________

Where did you hear about us?	_____________________________________________
Comments or Special Instructions	_____________________________________________

DISCLAIMER
By signing below, I swear under penalty of perjury that the following is true and correct. I am at least 21 years old. I am asking that Kick Ass Pictures send me sexually explicit materials. These materials will be used solely for my personal enjoyment, and shall not be resold, duplicated or commercially displayed. I will never let these materials be shown to minors, or to persons who do not wish to view sexually explicit materials.

Signature (REQUIRED): _______________________________________
Date: __________