Souvenir And Signup Print Order Form
print and mail to:
Roxanne Galla Enterprises, Inc.
703 Pier Ave. Suite B-122
Hermosa Beach, CA 90254

8x10 Mystique Color Photo

MYST1 - signed - $15.00
MYST2 - signed - $15.00
MYST3 - signed - $15.00
MYST4 - signed - $15.00
MYST5 - signed - $15.00
MYST6 - signed - $15.00
MYST7 - signed - $15.00
MYST8 - signed - $15.00


8x10 Head Photo

HPHOTO1 - signed - $10.00

Mystique Color Polaroid

MYSPOL1 - signed - $10.00
MYSPOL2 - signed - $10.00

Other Color Polaroid

OTHPOL1 - signed - $10.00


Postcard

POSTCRD1 - signed - $5.00
POSTCRD2 - signed - $5.00
POSTCRD3 - signed - $8.00

Mystique Trading Card

MYSTCARD1 - signed - $5.00

Poster

POSTER1 - signed - $10.00
POSTER2 - signed - $10.00


Playboy Magazine
PBMAG1 - signed - $20.00
PBMAG2 - signed - $20.00

Playboy Video

PBVID1 - signed - $30.00

Mousepad

MPAD1 - signed - $20.00

Lip Print

LPRINT1 - signed - $5.00

Personalized item(s) to be autographed
$10.00 per item.


Membership for Members Only Area
$12.95 per 1 months
$34.94 per 3 months (save $3.90)
$69.95 per 6 months (save $7.75)
Please allow 1 week for activation

Username: Password:


Fan Club (1) - $45.00 (save $15) plus $5.00 shipping
2 personally autographed 8X10's.
1 personally autographed postcard.
2 personally autographed mystique magazine trading cards.


Ultimate Fan Club (2)- $95.00 (save $35) plus $5.00 shipping
ALL THE ABOVE PLUS
1 more personally autographed 8X10.
1 perosnally autographed Playboy or Playboy NSS.
1 Tendy Turner and Roxanne Galla 2000 yellow Ferrari poster.
1 Playboy's "Girls of Mardi Gras" video.


 

Billing Information

First Name: Last Name:
Address:
Address 2:
City:
State: Zip:
Country
Email: Birthday:


Shipping Information

First Name: Last Name:
Address:
Address 2:
City:
State: Zip:
Country

 


 

Subtotal $
Shipping & Handling inside the US = $6.00
Outside the US add additional $10.00
Shipping & Handling $
California residents add 8.25% sales tax $
Total $

Credit Card Information
Visa & Mastercard Accepted!

Visa *** Mastercard *** American Express
Card # Exp.Date:

Please make all checks or money orders payable to Roxanne Galla.

print and mail to:
Roxanne Galla Enterprises, Inc.
703 Pier Ave. Suite B-122
Hermosa Beach, CA 90254

 

Please sign and date below to certify that you are at least 18 years of age!

Signature: ________________________________ Date: __________________