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Please print, fill out and send this form along with your money order.

Your User name and Pass word will be sent to your e-mail address

when your money order has been recieved.

MONEY ORDER FORM

Please start my Subscription to HOLEANDAHEARTBEAT.COM at $19.95 per month.

Please Check one Box

	1 Month
	2 Months
	3 Months-Special Priced Subscription for $50.00, Save $9.85
	6 Months-Special Priced Subscription for $90.00, Save $29.70
	12 Months-Special Priced Subscription for $150.00, Save $89.40

Please make Money Order payable to: HAAH, LLC.

MAIL TO: HAAH, LLC. 1735 Market St. Suite A486 Philadelphia, PA. 19103

Please choose a Unique Username and Password
You can make up anything you like!

User name_____________________________Password_________________________Your E-mail Address_______________________

LEGAL SIGNATURE

By signing hereunder I certify that I am 18 years of age or older. I am familiar with all local laws in my area affecting my legal right to access erotica; I have the legal right to access adult oriented material and that HAAH, LLC. has the legal right to transmit them to me. I am requesting adult-oriented entertainment for my own private enjoyment and I will never share these materials with a minor. Date of Birth ___/___/___

Signature_____________________________________________ Date _______________