Punished Brats Membership Mail Order Form
Please print neatly

Select membership option:

______ ..... 30 day membership ($22)

______ ......90 day membership ($58.50)

User ID:. ______________________________________________________________________________
..................Enter desired User ID. Must be at least 6 characters in length.

Password:. ____________________________________________________________________________
..................Enter desired password. Must be at least 6 characters in length.

Email Address: _________________________________________________________________________
..................Be sure to enter your email address so we can send notice of membership access activation and confirm ID and password.

Payment - Please circle one: ..... Check ...... Money Order
Make check or money order out to PB Productions
Please note if paying via check, membership will not be activated until payment has cleared

 

I hereby certify that I am at least 18 years of age.

SIGNATURE: _________________________________________

Send completed order form to:
PB Productions
P.O. Box 413
Doylestown , PA 18901