Pretty-Planet.Com Mail Order Form

Please complete the following fields and mail this form with payment to the address below
Name:


Address:


City/State/Zip:


Country:


Telephone Number:


Birth Date:


Email Address:


Username:


Password:


Membership Type:
Package #1 - 30 Day Membership - $29.95
 
Package #2 - 90 Day Membership - $69.95
 
Signature:


Please note by completing and signing this form you are verifying that you are 18 years or older.

Mail completed form along with Money Order to:

The Michael Scott Company
PO BOX 683
Lewis Center, Ohio 43035