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 and Canada (Air) add $14.99  
 S & H & I for Additional US and Canada (Air) items:          x $7.99  
Overnight Express (domestic only) add $99.95
S & H & I for Additional Overnight items:           x $7.99  
Deliveries outside the USA & Canada (Air) add $39.99  
 S & H & I for Additional Air Items (international only except Canada):            x $7.99  
Sales tax (NY residential only 8.875%$)
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.

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 and Canada on all orders over $150.00.
Free air shipping on all orders over $750.00 to International customers.
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 2006, Michael Salem Enterprises, Inc.