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| Lingerie Catalog Request Form |
| Please print this form, fill it
out completely and send it with $5.00 payment for shipping and handling to
the address shown on the form. We would send
your catalog with a $5.00 coupon you can use towards your first purchase
from the catalog. First Name __________________________________________ Last Name __________________________________________ Address: ___________________________________________ City __________________________ State/Zip ________________ E-mail address (if you have one) ____________________________ Please check the lingerie catalog(s) you are requesting: ( ) Shirley of Hollywood ( ) Intimate Attitudes ( ) Risque Lingerie (You may request more than one catalog. Please send $5.00 shipping and handling for each catalog) Send your completed form with $5.00 payment for shipping and handling to: Memory Impression (Make checks or money order payable to Memory Impression) Memory Impression will NOT give out your name, address or e-mail to anyone.
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