http://adultbabysource.com
http://xtremediaper.com
Name: ..............................................................
I am over the age of 18 years (sign) ......................................................
Desired Usrid (6-8 characters) ...................
Choose a Usrid that you do not think anyone else would use.
You can have the same Usrid/Password for both if you are joining both sites.
Desired Password (6-8 characters) ...................
Your email address .................................................................................................
For goodness sake, PRINT IT CLEARLY
You will be notified by email when your membership is set up.
(Tick) ...... Australian $40.00 for 30 days membership of ABS.
This is approximately equivalent to US$24.95. To check exchange rates exactly go to http://xe.com
(Tick) ...... Australian $47.00 for 30 days membership of XD.
This is approximately equivalent to US$29.95. To check exchange rates exactly go to http://xe.com
(Tick) ...... I want my 30 days membership to be automatically extended every 30 days and my credit card debited the above amount every 30 days.
To stop rebills email wendy@adultbabysource.com
Card Number: .............. ............. ............ .............. Exp. Date: ......... / ..........
Card Holder's Signature: ..............................................................................................
Print out this form, fill in the details, sign then scan and email to
wendy@adultbabysource.com