Order Form For Fax:
                                          
              Toll Free Fax Order Line:  (888) 339-8972
                 If Outside The US Use:  (215) 243-8834


    
    _______________________________________________________________
    Name   
    _______________________________________________________________
    Address (must be same as billing address for card)
    _______________________________________________________________
    City, State, Zip, Country
    _______________________________________________________________
    Mastercard / Visa                     Exp Date 
    _______________________________________________________________
    CVV2 (3 additional numbers on back of card)  Email or Phone      



             Item / Description           Option/Pal NTSC    Quantity   Amount
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                                                           | Subtotal |        |
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           Flordia Residents add 6% Sales Tax --------->   | Sale Tax |        |
                                                           ---------------------
                                                           | shipping |  6.95  |
                                                           ---------------------
                                                           |*Surcharge|        | 
                                                           --------------------- 
                                                           |  Total   |        |
                                                           ---------------------

     Surcharge of $6 for orders to Canada and $20
     for International Purchase Orders Europe/Asia
     Note: Sorry personal checks are not accepted. 

          *****I sign and Include the Statement Below with my order*****        
    ____________________________________________________________________________
      
    1.  I am at least 21 years of age.
    
    2.  The sexually explicit material I am buying and/or viewing is for my own 
        personal use and I will never expose minors to said material.
    
    3.  I am not a U.S. Postal official, or law enforcement agent, or acting as 
        an agent thereof, attempting to obtain any evidence for the prosecution 
        of any individual or corporation, or for the purpose of entrapment.
   
    4. I desire to receive and haven't notified the U.S. Postal Service, or any
       other governmental agency to intercept sexually explicit material.
    
    5. I believe that, as an adult, I have the unalienable right to read and/or
       view any type of material that I choose and that the material and images
       contained in these materials are not obscene or offensive in any way, nor
       could ever be construed to be obscene or offensive.
    
    6. The purchasing and delivery of the material and images offered by        
       CyberDream, Inc. do not violate the community standards of my street,    
       village, city, town, county, state, province, or country.
   
    7. That I am wholly liable for any false disclosures and responsible for any
       legal ramifications that may arise from requesting the delivery of the   
       HornyRob products, and that HornyRob.com., and its affiliates cannot 
       be held responsible for any legal ramifications that may arise as a      
       result of fraudulent purchase and delivery of it's products.



                                  _____________________________________________
                                           Signature              Date