Rebsart.com Membership Mail Order Form

To order rebsart.com membership by money order or check please make payable to
Reb Stout, complete the following information, and mail to:
(this form can be printed or you can provide the information any way you wish. No membership will be activated until the signed statement below has been received)

Reb Stout
PO Box 1416
Garden Grove, CA 92842-1416 U.S.A.

(Overseas customers please send International money order in U.S. dollars)

Please Check Desired Level of Membership:
90 days $39.95          1 year $99.95

Email address:
Password:

The day payment is received, an email will be sent to you letting you know that your membership has been activated.

Read and sign statement:
My signature below certifies that I am an adult, 18 years of age or older, and am lawfully entitled to receive, access and/or view adult materials in the community where I live. I understand that I am requesting material of an adult nature. I believe this material to be within the community standards of the area in which I live. I agree to not duplicate materials I receive or access. I certify that all of the aforementioned is true and correct to the best of my knowledge.

Signature:
 
Print: Name: