Fax or Mail-In Sign-up Form

This order form can be used for either memberships or videos or both. Please leave any selections
blank that do not apply. Address verification is in use to protect against credit card fraud.

Please enter desired Username and Password below:

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Hot Girl Fantasies :

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Hot Girl Fantasies membership is $19.95 per month or 3 months for $49.95. Membership is non- renewing. This charge will appear on your credit card statement as Viper Visuals Ltd. 508-291-0792

Please fill out, and fax this form to (001) 508-273-0299
If you are joining us by mail please be sure to send us the completed, printed form. If you are paying by check or money order please send us the completed, printed form along with your check or money order. Make checks/ money orders payable to: Viper Visuals Ltd.
Mail To: Viper Visuals Ltd.
16 Sconticut Neck Rd. #219
Fairhaven, Ma. 02719