Michael Salem Enterprises, Inc. 
Mail Order Form

(* Required entry)

Name:       *
Address:   *
City:       * State:  * Zip:                    *
Country: 
Phone:  Fax:
Email:  *
Today's Date *
Authorization: I certify that I am 21 years of age and believe this material to be within 
the community standards of my area.*
 Birth date:  *
Item Number or Name Color Size Quantity     Price         Total    
  $ $ *
  $ $
  $ $
  $ $
  $ $
  $ $
Include a Catalog with my order (@$8 each) $ $

Shipping, Handling & Insurance:		  
Domestic US (priority air) add $16.99  
 S & H & I for Additional US (priority air) items add:          x $7.99  
Overnight Express (USA domestic only) add $99.95
S & H & I for Additional Overnight items (USA domestic only) add:           x $9.99  
Deliveries outside the USA & Canada (Air) add $79.99  
 S & H & I for Additional Air Items (international only except Canada) add:            x $9.99  
Deliveries to Canada Only (air) add $39.99  
S & H & I for Additional Canada Items Only (air) add:                      x $9.99  
Free Ground Shipping to USA ONLY for Orders over $150.00  
Sales tax (NY residential only 8.875%$)
ORDER TOTAL $
         --We accept debit and credit cards.
Debit Card/ Credit Card Number:   *
Expiration Date:   *
Name on Card: *
Card Code: (for Visa & AmEx)
 

There will be an additional $49.99 handling charge if shipping to FPO and APO Boxes or for Saturday overnight shipping. This charge will be assessed manually after the order is placed.

We also offer special international 3-5 day express track-able shipping; call us for arrangements.

Please print this form on your printer and mail it to the address below 
OR you can call (212) 697-0644 and order by phone.
You may also pay by money order.

Free ground shipping to the USA ONLY on all orders over $150.00.
Items such as breast and vagina prostheses are sent as medical devices on the customs forms

For even more discreet delivering, we can arrange to have your
order shipped to a federal express office near your house.
We also ship to P.O. Boxes. Call 212-697-0644 for rates.

Orders can also be picked up AT OUR LOCATION by arrangement with our staff.  To arrange to pick up an order, please call (212) 697-0644 or (212) 986-1777/8.
For all other TV/TS information and in-person purchases call 1-800-550-TV69(8869).

Michael Salem Enterprises, Inc.
Phone: (212) 697-0644
PO Box 1781 - New York, NY 10150 

 
Michael Salem Boutique is a division of Michael Salem Enterprises, Inc.
The name you can trust, established 1969.
All items are sold as novelty only.
Copyright 2011, Michael Salem Enterprises, Inc.