X-STREAMS VIDEO AND DVD ORDER FORM (revised 04/13/10) Please circle format wanted: NTSC PAL (NOTE: NTSC is the format used in North American and Japan and PAL is used in most other countries. VHS tapes are no longer available.) All DVDs are shipped directly by X-Streams from the UK! Please check each item that applies: SERIES 1 DVD ___ Drew Pt. 1 ($35.00) ............................... $___________ ___ Drew Pt. 2 ($35.00) ............................... $___________ ___ Kelly Pt. 1 (with Louise) ($35.00) ................ $___________ ___ Kelly Pt. 2 ($35.00) .............................. $___________ ___ Kerry Pt. 1 ($35.00) .............................. $___________ ___ Kerry Pt. 2 ($35.00) .............................. $___________ ___ Carly & Sarah ($35.00) ............................ $___________ ___ Drew in the Dunes ($35.00) ........................ $___________ ___ Laura Goes Shopping Pt. 1 ($35.00) ................ $___________ ___ Laura Goes Shopping Pt. 2 ($35.00) ................ $___________ ___ The Piss Sisters Day 1 ($35.00) ................... $___________ ___ The Piss Sisters Day 2 ($35.00) ................... $___________ SERIES 2 DVD ___ Toni in Trafalgar Square ($38.00) ................. $___________ ___ Katie & Emma in Covent Garden ($38.00) ............ $___________ ___ Katie & Emma Soak Each Other ($38.00) ............. $___________ ___ Liz & Helen's Big Day Out ($38.00) ................ $___________ ___ Nicky & Becky (Tour de London) ($38.00) ........... $___________ ___ Patricia La French Pisser ($38.00) ................ $___________ ___ Brandy on the Rocks ($38.00) ...................... $___________ ___ Carry on Piss Sisters ($38.00) .................... $___________ ___ Brandy Rocks On ($38.00) .......................... $___________ ___ Tanya's Toilet Dare ($38.00) ...................... $___________ ___ Tanya's Toilet Training ($38.00) .................. $___________ ___ Patricia & the Air Stewardess ($38.00) ............ $___________ SERIES 3 DVD ___ Champagne Picnic Pt. 1 ($40.00) ................... $___________ ___ Tanya's Litte Surprise ($40.00) ................... $___________ ___ Cathy & Greg Pt. 1 ($40.00) ....................... $___________ ___ Mother & Daughter ($40.00) ........................ $___________ ___ Pregnant Pissing ($40.00) ......................... $___________ ___ Pee for Paris Pt. 1 ($40.00) ...................... $___________ ___ Kellog the Cascade Kid ($40.00) ................... $___________ ___ Pee for Paris Pt. 2 ($40.00) ...................... $___________ ___ Kellog & Ellie Play Crazy Golf ($40.00) ........... $___________ ___ Desperate Measures ($40.00) ....................... $___________ ___ Cathy & Greg Pt. 2 ($40.00) ....................... $___________ ___ Waterways ($40.00) ................................ $___________ SERIES 4 DVD ___ 3 Girls Pee Berlin Pt. 1 ($43.00) ................. $___________ ___ Madam Pee Pee ($43.00) ............................ $___________ ___ A Winter Wettingland Pt. 1 ($43.00) ............... $___________ ___ 3 Girls Pee Berlin Pt. 2 ($43.00) ................. $___________ ___ Champagne Picnic Pt. 2 ($43.00) ................... $___________ ___ German Water Marks ($43.00) ....................... $___________ ___ Mother and Dauther in Spain Pt. 1 ($43.00) ........ $___________ ___ The Sexy Secretary ($43.00) ....................... $___________ ___ 3 Girls and a Dwarf Pt. 1 ($43.00) ................ $___________ ___ Mother and Dauther in Spain Pt. 2 ($43.00) ........ $___________ ___ A Winter Wettingland Pt. 2 ($43.00) ............... $___________ ___ 3 Girls and a Dwarf Pt. 2 ($43.00) ................ $___________ SERIES 5 DVD ___ Pees and Queues ($45.00) .......................... $___________ ___ Swan Leak ($45.00) ................................ $___________ ___ Cemetery Skull Duggery Pt. 1 ($45.00) ............. $___________ ___ Traci’s Trickle Treats Pt. 1 ($45.00) ............. $___________ ___ Cemetery Skull Duggery Pt. 2 ($45.00) ............. $___________ ___ Traci’s Trickle Treats Pt. 2 ($45.00) ............. $___________ ___ Pee Marks the Spot Pt. 1 ($45.00) ................. $___________ ___ Pissing about in London Pt. 1 ($45.00) ............ $___________ ___ Palace Pissing ($45.00) ........................... $___________ ___ Pissing about in London Pt. 2 ($45.00) ............ $___________ ___ Katie’s Dirty Deed Diary ($45.00) ................. $___________ ___ Cheers & Cherio ($45.00) .......................... $___________ SPECIAL SERIES DVD ___ Lesbian Piss Girls Pt. 1 ($35.00) ................. $___________ ___ Lesbian Piss Girls Pt. 2 ($35.00) ................. $___________ ___ NEW Pee Spy GOLD Pt. 1 ($35.00) ................... $___________ ___ NEW Pee Spy GOLD Pt. 2 ($35.00) ................... $___________ ___ ORIGINAL Pee Spy Pt. 1 ($25.00) ................... $___________ ___ ORIGINAL Pee Spy Pt. 2 ($25.00) ................... $___________ ___ ORIGINAL Pee Spy Pt. 3 ($25.00) ................... $___________ MILLENNIUM SPECIAL DVD ___ Millennium Special - 100 Pee Scenes ($45.00) ...... $___________ ___ Millennium Special 2 - 100 Pee Scenes ($45.00) .... $___________ SPECIAL OFFERS DVD ___ All 12 Series 1 Titles ($340.00) .................. $___________ ___ All 12 Series 2 Titles ($360.00) .................. $___________ ___ All 12 Series 3 Titles ($385.00) .................. $___________ ___ All 12 Series 4 Titles ($405.00) .................. $___________ ___ All 12 Series 5 Titles ($450.00) .................. $___________ ___ All 7 Special Series Titles ($160.00) ............. $___________ ___ Both Millennium Titles ($80.00) ................... $___________ Australian orders paid by credit card will have a 10% GST tax added to their total .................... $___________ Shipping Charges for orders: Shipping to the UK and Europe - ___ 1 title - add $2.00 ............................... $___________ ___ 2 titles - add $4.00 .............................. $___________ ___ 3 titles - add $6.00 .............................. $___________ ___ 4 titles - add $8.00 .............................. $___________ Shipping elsewhere - ___ 1 title - add $2.50 .............................. $___________ ___ 2 titles - add $5.00 .............................. $___________ ___ 3 titles - add $7.50 .............................. $___________ ___ 4 titles - add $10.00 ............................. $___________ Total $___________ ___ Do NOT send me information about new products. ___ Send future info by ___ e-mail or ___ to my mailing address. PAYMENT METHOD: ___Check ___Money Order (payable to Patches' Place) ___ Cash ___Visa ___MasterCard ___ Bankcard Card #_________________________________________ Expires ___________ Security Code ________ (last 3 digits on the back of the Credit Card above your signature) Credit card payments will show the name "Zampala Online" on your statement. Cash payments must be in US dollars. Personal checks from outside the US are not acceptable. International Money Orders from outside the US must be payable in US dollars and have the name of the US Bank where the money order can be cleared printed on the face of the money order. CERTIFICATION STATEMENT AND SHIPPING ADDRESS: I certify I am over 21 years of age and am requesting these sexually oriented materials. I believe the scenes described in any videos I order are within the "community standards" where I live. I certify I am not a city, state, or federal law enforcement officer for the United States nor any other country, nor a postal inspector for any country, nor am I requesting materials as evidence in prosecuting or harassing any individual or organization. Any video sent to me is for my personal use only and will not be shown to minors nor sold, traded or given to others. I have not requested anyone to "protect" me against receiving sexually oriented material nor signed any forms intended to block the receipt of sexually oriented material. If I am ordering from outside the United States, I understand all videos are legal for sale in the USA but that Patches' Place and other represented video producers cannot predict nor be responsible for the actions of customs agents in my country nor any intermediate country. I release Patches' Place and other video producers from any responsibility or liability for the acts, omissions or errors of the government of my country or any intermediate country. I am responsible for any import duties that may be required. Signed ____________________________________ Date __________________ E-Mail address for confirmation or questions________________________ PRINT CLEARLY Name _______________________________________________________________ Address ____________________________________________________________ City _____________________________ State or Province _______________ Zip _________________ Country (if outside U.S.A.) _________________ You can phone your order to Patches' Place by calling 585-218-9928 or send this order to Patches' Place, PO Box 24192, Rochester, NY 14624, USA.