You can pay online or
if you prefer fill in the for and send it back to us -
Please use this
printable form if you prefer to pay by cheque or postal order.
Upon receipt
of this form and payment we will contact you via email to check
that we have your email address correct, and to confirm that your
membership has been set-up.
Choose your
preferred username: ______________________
(Usernames must be between 8 and 15 characters in length)
Choose your
preferred password: ______________________
(Passwords must be between 8 and 15 characters in length)
Your email
address: ______________________________________
(It will NEVER be sold, rented or made available to any third-party,
for more information please review
our privacy policy)
£4.99 (1 month membership)
£9.99 (3 months membership)
£29.99 (12 months membership)
Please make
fees payable to:
Insight
25 Smallbrook Road
Broadway
Worcestershire
WR12 7EP
Signature:
______________________________ Date: ___________
By
signing this form you are deemed to have read and agreed to the
Terms & Conditions.
N.B
adultXads is the property of 365adultshop & Insight