ORDER FORM
Must be filled in by the inmate!
Print this form and return it with your ad, photo, and payment.

FULL NAME _________________________________ PRISONER ID#_____________

NAME OF THE PRISON __________________________________________________

ADDRESS ____________________________________________________________

CITY/STATE/ZIP______________________________________________________

Your Sex: Male Female (circle one)
Your Race: ______________________ Date of Birth: _________________
Height: _______ Weight _______ Eye color________ Hair color ________

Convicted of: _________________________________________________

Serving a life sentence: Yes No (circle one)                    On Death Row: Yes No (circle one)
Incarceration date: _________________             Length of sentence: ___ years.
Current Release Date: ______________

Attention! All of the above is required information, and it must be accurate. This information will be posted in your ad, and we will not process your request without it. Detach and return this order form along with your payment (we do not accept stamps as payment.)

•INMATE Classified reserves the right to deny service to anyone at any time. •INMATE Classified may cancel your ad at any time, with or without reason, at INMATE Classified’s sole and absolute discretion, and you will be refunded the remainder of your subscription, if any. •Sexually explicit, pornographic or obscene material is prohibited. •Improper use of this service to deceive the public or spread material of a threatening or libelous nature will result in immediate termination of your service. •This service does not guarantee results or responses to your personal ad. Our responsibility is limited to the design and publishing of your ad on our web site. •The location or position of your ad on our web site is at INMATE Classified’s sole and absolute discretion, and it may change anytime without notice to you. •This is not a dating service! •Once your ad is on the Internet there will be no refund, total or partial.

Agreement: I have read and understood the information contained on this page. I agree to follow all current and future rules and regulation set by INMATE Classified.

YOUR SIGNITURE: ___________________________________________

I WAS REFERRED BY: ______________________________________

The person who referred your gets one free month on our service.
You’ll also get one free month for each new paying client you refer.

MAKE YOUR CHECK OR MONEY ORDER PAYABLE TO:
INMATE Classified, P.O. Box 3311, Granada Hills, CA. 91394
Voice Mail: (818) 474 -7222
On The Web: www.inmate.com