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# PLEASE PRINT THIS OUT AND RETURN IT SIGNED AND DATED       #
# ALONG WITH YOUR PAYMENT TO THE ADDRESS AT THE BOTTOM.      #
# YOUR MEMBERSHIP WILL BE CONFIRMED VIA EMAIL WHEN WE        #
# RECEIVE YOUR PAYMENT, AND THIS FORM FILLED OUT AND SIGNED. #
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Peepholecam Membership Application

I certify that:

1: I have read and I agree to the TERMS and CONDITIONS of Membership to
PEEPHOLECAM.COM Adult Web site.

2: I am at least "18 YEARS OF AGE (or 21 in certain jurisdictions)" and am
permitted by law to view Adult materials in my locale ( Country, State,
Province ) and I understand that the contents of PEEPHOLECAM.COM are of a
sexual nature.

3: That my PEEPHOLECAM membership will be used for my own personal enjoyment
and that I will not under any condition, share or transfer my membership.


My Name...: _________________________________________________

My E-Mail.: _________________________________________________

My Country: _________________________________________________

VERY IMPORTANT, if you don't include your date of birth we will not accept
your payment and registration to our web site !!!

IMPORTANT:

Date of Birth...: _________________________________________________

State / Province: _________________________________________________

Pick Username: _________________________________________________

Pick Password: _________________________________________________

How much of a subscription length would you like? Place an "X" next to your selection

One Month $19.95      ___

Two Months $35.95   ___

Six Months $90.00     ___

**All amounts are in U.S. Funds**

VERY IMPORTANT, if you don't include your signature and date of signature we
will not accept your payment and registration to our web site !!!

*** Signed: _________________________________________________

*** Date  : _________________________________________________