CASH, CHECK, OR MONEY ORDER SUBSCRIPTION FORM FOR HOT WIFE RIO
First Name -
Last Name -
Address -
Address 2 -
City, State & Zip Code -
Country-
Date of Birth -
Email Address - 
Username - (6-8 characters):
Password - (6-8 characters):
Send Me Email Updates? - Circle one   Yes / No
Membership Type? - Check one  
$29.99
30  Days
   
$59.99
90 Days - Equals 1 Month Free
   
$89.99
150 Days - Equals 2 Months Free
Signature: Date:
Please note by completing and signing this form you are verifying that you are 18 years or older.

* NOTE: I will e-mail you your username and password the same day I receive payment if you choose to pay with cash or money order. However, if you choose to pay with a check I will e-mail your username and password after your check has cleared my bank (usually 10 - 14 business days).
PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO: T MEDIA
Print, Sign, and Mail this form with your cash, check, or money order to:

T Media
8987 E. Tanque Verde Rd.
Suite #309-141
Tucson, Az. 85749