ORDER FORM FOR SCOTTOHARA.COM

Order your copy of Scott's book, AUTOPORNOGRAPHY, or a copy of the frameable photo of Scott doing his infamous SELF-SUCK. Just print out this form and mail it to the address below.

Please mark the products you would like to purchase being sure to double-check your responses when through!!!

AUTOPORNOGRAPHY -- Life In The Lust Lane ... $16 includes shipping in the USA. International orders please send $26 which includes Global Priority Mail Shipping

Poster of Scott in his infamous SELF SUCK pose ... $40 includes UPS shipping in the USA. Shipped flat and securely. Can not be shipped out of the USA due to size limitations.

AUTOGRAPHED Poster of Scott in his infamous SELF SUCK pose ... $100 includes UPS shipping in the USA. Shipped flat and securely. Can not be shipped out of the USA due to size limitations.

ORDER INFORMATION

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write in "don't call" if you don't want me to ever call but you still MUST give phone

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PLAIN TALK DISCLAIMER

By submitting this form, under the penalty of perjury, I solemnly swear, declare and affirm that I am an adult, being over the age of 21, and I am not ordering products for use against the seller/provider or any person whatsoever in any conceivable manner. I will not permit any minor to view said materials. I am not an agent or employee of the US. Postal Service or any other US. Government agency, ordering or asking for said information or materials for the purpose of entrapment or any other sort of legal prosecution, whether I am using my given name or an alias. If you do not use your true given name, you are guilty of forgery.

Send your order to:

Winter Publishing, Inc
PO Box 80667
Dartmouth, MA 02748 USA

All orders are processed on a computer that is secure, it is NOT the same machine that I do my Internet work on. The machine is not connected to the Internet to ensure your security. Each order is MANUALLY processed by Rick to ensure NO security breaches whatsoever.

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FIRST NAME:
LAST NAME:
MIDDLE INITIAL:




BILLING ADDRESS
STREET ADDRESS:
CITY:
STATE/PROVINCE:
ZIP:
COUNTRY:




SHIPPING ADDRESS
STREET ADDRESS:
CITY:
STATE/PROVINCE:
ZIP:
COUNTRY:




E-MAIL ADDRESS:
TELEPHONE:
write in "don't call" if you don't want me to ever call but you still MUST give phone
DATE OF BIRTH:

Number:
Expiration Date:
Name On Card:
Card Identification Number:

	The Card Identification Number (Card ID) is required for American Express, Visa and MasterCard. The Card ID is an added security feature to help protect you against online fraud.
			American Express 4 digits on front of card		Visa and Mastercard last 3 digits on back of card