MAIL ORDER VIDEO FORM
Print this form and fill it out completely.
 Mail to: G A  Productions
 POB 742272
 Riverdale, GA 30274
MERCHANDISE& VIDEOS ARE FOR LEGAL ADULTS ONLY

By signing this form I hereby swear, certify and affirm that: I am of legal age as defined by the laws of my residential state.and aware that this is adult material with BDSM, fetish and discipline themes. I am also aware of my local laws and am taking full responsibility and liability for video contents.

Signature: 

Date:

Name:

Address:

City, State, Zip:

Country:

email address: (used only to notify you of video delivery)

Phone (optional):

List the videos you wish to purchase

Video Title-
DVD or VHS-
Quantity-
Price-

Video Title-
DVD or VHS-
Quantity-
Price-

Video Title-
DVD or VHS-
Quantity-
Price-

Video Title-
DVD or VHS-
Quantity-
Price-



If this is a cashiers check or money order, make it payable to G A Productions. 
Total amount: ______ 
Shipping cost: ______(USA - $5.00/ International - $10.00)
Grand Total: ______          
Mail to: Goddess Amazon Production
POB 742272
 Riverdale, GA 30274
Call 770-472-1912 10 AM - 11 PM EST for any questions pertaining to your order.