High Impact Humor -- Bill's Pills

Bill's Pills Recipient List
Once you have purchased Bill's Pills, use this form to submit your list of recipients.  
You can also use this form to submit additional names if the initial list has already
been submitted.
Your Name
Your e-mail
Address
Payment has been submitted by...
PayPal
Other  (Please specify)
Please check one:
This is the initial list
These are names to be added to the initial list
Enter recipients' e-mail addresses here, separated by commas
(type-in or copy-and-paste)...