EXTREMEBOOTY.COM                                         MAIL ORDER FORM
Please print this form and mail it with your payment.

PLEASE SHIP MY ORDER TO:
NAME: AGE:
ADDRESS: CITY/ STATE/ ZIP:
TELEPHONE #: E-MAIL:

Payment: Enclosed is a check or Money Order for $ ______   made payable to “TCE ONLINE .”
Please bill to my: Mastercard Visa American Express Discover

Card #   Exp. Date: (CVV) 3- or 4-digits on back of card:
Name as it appears on card: Shipping & Billing are the SAME
Billing address for credit card: City/ State/ Zip:

Signature: _____________________________________ By signing here I certify that I am atleast 18 years of age or older.

  Please complete your order by writing in your selections below:

QTY ITEM OR PRODUCT NAME COST
     
     
     
     
     
     
     
     
     
     
     
     
     
 
SUB-TOTAL
 $
 
Choose your Shippping Option:
FREE (7 to 10 bus days) $5.00 (3 to 5 bus days)
$30.00 (Express Delivery - US & Canada only)
[ International Customers use shipping calculator ]
SHIPPING
$                     
 
TOTAL AMOUNT
  $

Mail order form and payment to:
TCE ONLINE LLC. - P.O. Box 742950 - Riverdale, GA 30274

Orders can also be placed via: Telephone: 888-922-6689 or www.ExtremeBooty.com