Age verification is VERY important. NO MINORS WILL BE ALLOWED ACCESS. Since my site contains EXTREMELY graphic sexual images and content, I must receive a signed statement of age before you can gain access.
Please print out this page and fill in the required areas.
Please check one of the following options:
____ 30 days access for $25.00
____ 90 days access for $60.00
Your desired: Username:________________ Password:_______________ Username and password should be 8 to 10 characters long each. Send the above form (signed and dated) to the address below, along with your money order:
Black Jac Media
22704 Ventura Blvd # 384
Woodland Hills, CA 91364
**Please make money orders payable to Black Jac Media . No personal checks please**
18 U.S.C. 2257 Record-Keeping Requirements Compliance Statement.