SAMANTHA ANDERSON
P.O BOX 91124
LAKELAND, FL 33804-1124
Phone (239) 418-6207
E-MAIL: TravelingDom4U@aol.com
WEBSITE www.samanthaanderson.net
Adult Disclaimer & OrderForm

During Her $6 video sale Mistress is offering "grab-bags" of 3 kinky videos delivered for $18. That's $6 per DVD or VHS tape - including shipping and handling - sold in lots of 3. So 6 DVDs are $36 or 6 tapes are $36 and shipping is *FREE*.

Sale items are offered "as is" with no returns or exchanges. ALL SALES ARE FINAL. At these prices we're not posting a list of what's available because the list would change DAILY. Just print, complete and mail this form to tell us your interests and enclose your payment. We'll try to send videos that match them but we make NO promises! Sale items will be sold and shipped on a first-come-first-served basis until we run out. Then there'll be no more...

Hurry. O-R-D-E-R  N-O-W!!!

Mistress Samantha

POINTS OF INTERESTS: Place a Check next to your main interests:

Bondage Boot worship
Flogging Cigarette Burning
Spanking Nipple Torture
Whipping Two Mistress's
Dildo Training Master & Mistress OR TV
Forced Cocksucking: Real T/V Mistress
Forced Cocksucking: Dildo Female Submissives
Golden Showers Ultra-Violet Wand
Enema's Enema's
Hot Wax Cross Dressing



Ship to:

Your Name __________________________________________________

Your Address ________________________________________________

City ________________________State _________ Zip _______________

I hereby certify, by my signature below, that I am an adult 21 years of age or older. I desire to receive sexually oriented material for my personal use and will not knowingly make this material available to minors. I further certify I am not a city, county, state, federal or other political subdivision law enforcement officer, nor am I an official of the U.S. Postal Service ordering this material as evidence for the prosecution or harassment of any individual or organization. By my signature, I guarantee that I have not, as of the date indicated thereon, signed U.S. Postal form 2201 (pursuant to 38 USC 3010 or replacement forms or revisions thereto) and I hereby and affirm I have no intention of signing Form 2201 or replacement forms or revisions thereto in the future.

I further certify I have no known medical problems, either physical or mental, that would endanger either myself or anyone else from the use of or participation in any activities ordered, depicted or requested.

By signing below, I am exercising my freedom of expression as stated in the United States Constitution.

_____________________________________________________________

(Printed Name)

_____________________________________________________________

(Mailing Address)

Material Requested:______________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

(signature)____________________________________________________

Date_________________________________________________________

Orders cannot be processed without this signature!

Print this form, fill it out completely, and mail it
along with your cash or blank money order to:

Samantha Anderson
P.O. Box 91124
Lakeland, FL, 33804-1124

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