SURFACE ORDER FORM
A.E.S. PRODUCTIONS
17 Stephen Street. #2
Lemont,IL 60439

Please use this form if you wish to pay by personal check, money order OR credit card but not use the onl-line system.    To print this form, simply click on your "Print" feature. For credit card orders, this form may be MAILED to above address.

I certify that I am at least 21 years old.  I am aware that you are sending me sexually oriented material which is only for my use and will not be resold or in any way be distributed -- especially to minors.

PLEASE PRINT CLEARLY

IF WE CAN'T READ YOUR NAME OR ADDRESS WE CAN'T SHIP THE MATERIAL.

FIRST NAME._____________________LAST NAME______________________________________

STREET ADDRESS___________________________________________________________________

CITY_________________________________________STATE________ZIP_____________________

EMAIL ADDRESS__________________________________

Signature:___________________________________________________
(Needed for Disclaimer. Without this signature we can't send any orders or monthly mailings).

Personal Check enclosed___________  (Order held until check clears).
Money order enclosed___________.
Charge my: _____ Visa _____Mastercard

Account #: __________________________________________________________
Expiration Date: ______________________ CVV Code (3 Diget code on back) _____________
Signature: __________________________________________________________
Print Cardholder's Name: ______________________________________________
Please send the following items. (List I.D. Letters and Numbers i.e.: KS-11, CV-23)
___________________________ Price _____________
___________________________ Price _____________
___________________________ Price _____________   (DVD ONLY)
___________________________ Price _____________  
                                                Sub-Total: ____________    
ILLINOIS RESIDENTS ADD 7.75% Tax:_________
                                                     P&H:______________(U.S. $7.00 PER ORDER
                                                                                            Canada $8.00 per DVD
                                                                                           OVERSEAS  $7.00 per DVD.)   
                                              Total of Order:__________

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Email AES PRODUCTIONS with any questions.