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If this form is not included, your payment will be returned to you!

( If you do not have a printer - you may hand write this information)
Authorization: By signing this form I declare that:

1.) I am an adult, 18 years of age or older.
2.) I am requesting and agree to accept sexually explicit material to be sent to me for my personal use.
3.) I will not copy, sell, or exhibit these products to minors or anyone else that may be offended by them.
4.) I have not requested the Post Office or any other person or agency to protect me against receipt of sexually explicit material, nor am I acting in an official capacity for any public authority of any kind.
5.) I declare that all of the above statements are true and correct and hereby authorize RubysDesire.com to ship to me sexually explicit materials which I have ordered.

Print Name: _________________________________________  

Signature: _________________________________________

Birthdate: ______________________ 

Date: ______________________