Bronzebear Media Distribution

Liquidation order form

Please familiarize yourself with the ordering instruction page before placing your order

Name:
Address:
Address:
Phone Number:
Email:
Please remember to include payment (made out to Matt Henry), the age statement, and alternate choices.
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Order Subtotal \$
Certified/Return Reciept (if desired-- \$2.65)$
Insurance (if desired-- \$2 for $100, $1.25 for additional $100)$
Shipping (see shipping chart, based on total)\$
Final Total \$
ALTERNATES LIST
Because this is a liquidation, with no restock options available, there is a chance items might be out of stock. In that event, we need a list of alternate items from the liquidation list, in a prioritized order. We recommend that alternates equal half of the total of your order.
ItemBox # Name of item QuantityPrice
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AGE STATEMENT

I certify by my signature that I am willingly requesting material of a mature nature. I am an adult of at least 21 years of age, and am not a member of local, state, federal, or international law enforcement. I also certify that this material is for my own use in the privacy of my own dwelling, and do not hold Bronzebear Media Distribution or any of its vendors responsible for legal or emotional after effects incurred by my posession of this material.

Name (signature) Name (printed) Date
. . .

Please mail orders to:


Bronzebear Media Distribution


PO Box 770742


Orlando, Fl 32837


Orders paid for via Paypal can be sent directly to: bronzebear@cfl.rr.com for faster processing