I, the undersigned, hereby certify that I am an adult, at least 18 years of age.
I am aware that I am requesting access to www.tigerrjuggs.com, which is an adult website containing materials that are sexually-oriented.

My name is:______________________________ (please print clearly)

My email address is: ___________________________________________(We cannot verify ANY membership without a valid email address!)

Signed:____________________________ (You MUST sign your name)

Dated:_____________________________

Please let us know your desired

username:____________________________

password:____________________________
(Usernames and Passwords are case sensitive)

Instructions:
Print out and send this completed form and payment to the address below.
If you cannot print this form out, you MUST write out:

"I, the undersigned, hereby certify that I am an adult, at least 18 years of age. I am aware that I am requesting access to www.tigerrjuggs.com, which is an adult website containing materials that are sexually-oriented"

Also include your address and required password details.
Please understand that you send cash at your own risk - Euros and US Dollar and GB Pounds equivalents only! We cannot accept any other currency.
Sorry, but at this time we do not accept checks or money orders.

Send To:
Benson Media, Postbus 3557, 1001 AJ Amsterdam, The Netherlands

We will notify you via email when your account has been activated.
Please use a valid email (ALL memberships will be confirmed by email - so please supply a real email address!) account written clearly so we will be able to reach you.

Need Help?
If you need any further assistance in filling out this form please email us at office@benson-media.com

We look forward to seeing you in the members Area!