Encrypted Order Page
Signup "In Advance" of Payment!

Don't have a credit or bank debit card. No problem! Here's how to get quick access to the “Safe Sex-Get Paid” & “BlackBook” hottest new listings! Just sign up "in advance" of payment! Complete the form below and mail it in with your payment: money order, check or cash! And, since you have already signed up, you will be sent a confirming email immediately upon receipt of your payment at our membership center.

Fill out the form below to reserve your personal username and password.
Click the "Process My Request" bar at bottom of form. Then confirm your information and then proceed to final checkout.
Print out your final confirmation page and mail in with a $12.95 money order.(Check payments accepted, but allow 7 days for bank clearance before your account is activated. Cash payments also accepted.)
Immediately upon receipt of payment your username and password will be activated and you will be sent a welcome email confirming your account activation.

NOTE: You will NOT HAVE ACCESS to the online database until your payment is received.

* I have read & agree to the Terms and Conditions.

NOTICE: DO NOT USE THIS FORM UNLESS YOU INTEND
TO SEND IN YOUR PAYMENT WITHIN 30 DAYS OR THE
SYSTEM MAY DENY YOU MEMBERSHIP FOR UP TO
1 YEAR DEPENDING ON MEMBERSHIP ACTIVITY.

Mail-In $12.95 Payment for 6 Month Access  

Enter name of publication, radio station, search engine, or just where you saw our ad: *


Customer Information
Fields marked with an asterisk
are required input fields.


First Name *
Last Name *
Address *
City *
State *
Postal Code (ZIP) *
Country *
Telephone Number *
E-Mail Address *

Choose a User Name
User Name *

Choose a Password

Password *
Verify Password *


Copyright © 2004 National Research Group. All Rights Reserved.   Privacy Policy.