Michael Salem Enterprises, Inc.: Fax/ Mail Order Form

Michael Salem Enterprises, Inc. 
Mail Order Form

(* Required entry)

Name:       *
Address:   *
City:       * State:  * Zip:                    *
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 $150.00  
Sales tax (NY residential only 8.875%$)
         --We accept debit and credit cards.
Debit Card/ Credit Card Number:   *
Expiration Date:   *
Name on Card: *
Card Code: (for Visa & AmEx)


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.

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.

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.

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 on Happy New Year 2019

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 2015, Michael Salem Enterprises, Inc