MEMBERSHIP MAIL- IN FORM

Please print out the following form. Fill it out legibly. Attach cash or a money order ONLY, made out to "T & B Hosting". ...(we do not take personal checks and will void them if we receive them.)  Mail to:
T & B Ventures
P.O. BOX 15
LAND O' LAKES, FL. 34639-0015
________________________________________________

NAME: _____________________________________________________________

Street Address:________________________________________________________

City/Town:___________________________________________________________

State/Providence:______________________________________________________

Country:_____________________________________________________________

Postal Zip Code:________________________

E-mail Address:________________________________________________________ (print clearly)

Subscription Length Desired:

30 day membership ________ $30.00 U.S. Dollars

3 month membership________$60.00 U.S. Dollars

6 month membership__________$100.00 U.S. Dollars

Username:__________________ (5-15 characters) print clearly

Password:___________________(5-15 characters) print clearly

YOU WILL BE NOTIFIED BY E-MAIL AS SOON AS YOUR ACCOUNT IS ACTIVATED.

I CERTIFY THAT I AM OF LEGAL AGE IN MY AREA OF RESIDENCE TO VIEW IMAGES AND 
TEXT MEANT FOR MATURE AND ADULT AUDIENCES.

SIGNED:________________________________________

DATE:__________________