*First Name :
*Last Name :
*Address 1 :
*City :
*State :
*Zip :
*Email Address (Email addresses will be validated to insure that spammers do not receive a taste of Rosie's Vagina (tm) without verifying authenticity) :
Alternate Email Address :
*Birth Date :
* Gender:
*Marital Status :
I would like to receive aggressive, personal solicitations from Rosie O'Donnell.

I would like more information about selling the potent, aromatic fragrance of Rosie O'Donnell's Vagina to my friends, family and loved ones.

I would like to receive tips on health, fitness and beauty from Rosie O'Donnell

How often do you purchase the following items:


Rosie's Vaginal Products

Smell-based Products

Trowel Applied Cosmetics

Brackish Bath & Body Waters

How often do you purchase the following items:


Cosmetics (foundation, mascara, spackle, etc.)

Fragrances (Perfume, body spray, RAID, catnip, etc.)

Personal Care (Deodorant, aftershave, benwah balls, sweat-reflavorer, etc.)

Bath & Body (Lotion, soap, hair-detangler, vajerry curl activator, etc.)

Where do you typically purchase these types of products? (Check all that apply)
K-Mart Chinese Buffet Waterloo Implement Inc.
Walmart Osco Schuck's Auto Supply
Home Depot 7-11 Denny's
Petco Blain's Farm & Fleet Amish Connection
Chevron Arby's Durden Soilent Cosmetic Supply
Dollar Store Harley Davidson Dealer Motel Six
Please allow 10-12 weeks for the secretion and shipment of your product. Available to US residents only.

Limit one sample per domestically partnered household. You must be over the age of 14 to receive this product, and over the age of 18 to legally ingest it (16 Nevada, 14 Mississippi.)