Order Form

Print out this form and send to purchase videos

Send Money Order To  :
Lorelle Pickett,
West Farms Station,
PO Box 726,
Bronx NY 10460

Order From:  Name__________________________________________ Date________

Address________________________________________________________________

City______________ State________  Zip Code________________________________

Email__________________________________________________________________

Certification of Age:

I am at least over 18 years of age and permitted to receive sexually oriented materials in my locality. 
I hereby authorize Lorelle Pickett to mail them to me.  (We are NOT responsible for orders detained by authorities
and will NOT reship them at no charge.)

Date________________Birthdate________________
Signature__________________________________________________

How did you first hear of Bustybabydolls.com?________________________________________