Official N-Word Pass Order Form by Burt Bronx

Official N-Word Pass Order Form by Burt Bronx

Use this form to get an official N-Word Pass by Burt Bronx: FishTank Season 3 Winner
TODAY'S DATE

MonthDayYear
Date
Hour MinutesAM/PM Option
OFFICIAL ORDER ID NUMBER
BURT BRONX CORP

Burt Bronx (Founder & CEO of Burt Bronx Corp) provides personalized video messages, private video chats, merchandise sales, and fan-focused events, including online Q&A sessions, autograph signings, live appearances, podcast interviews, photoshoots, and social media collaborations.

More exclusive opportunities include event hosting, corporate cameos, brand endorsements, and acting roles.

Services are tailored to customer needs, with payments processed at checkout and fulfillment delivered within 3–7 days for digital offerings or as scheduled for in-person engagements.
NAME: Type the NAME you prefer Burt to call you.*

First NameLast Name
EMAIL: Type the EMAIL ADDRESS that you most frequently check.*
CELL PHONE NUMBER: Type your cell phone number that can receive text messages.*
N-Word Pass Certificate - Design A
N-Word Pass Certificate - Design B
N -Word Pass Certificate - Design C
N-WORD PASS CERTIFICATE DESIGN: Choose the option you like most*

Design ADesign BDesign C

OFFICIAL N-WORD PASS CERTIFICATES*

1 Hour (Verbal Declaration on Burtstream)

Official N-Word Pass Declared Live on Burtstream

$10.00

	Quantity
Design A
Design B
Design C

Item subtotal:$0.00

24 Hours (Hardcopy)

Official N-Word Pass Declared, Signed, and Shipped to you by B.U.R.T. himself.

$25.00

	Quantity
Design A
Design B
Design C

1 Week (Hardcopy)

Official N-Word Pass Declared, Signed, Framed, and Shipped to you by B.U.R.T. himself. includes FREE Bonus Burt Trinket.

$50.00

	Quantity
Design A
Design B
Design C

Enter coupon

Subtotal

$0.00

Shipping

$0.00

Total

$0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

N-WORD PASS START DATE:*

MonthDayYear
Date
Hour MinutesAM/PM Option
USER: Is this N-Word Pass for you or someone else as a gift?*

Me OnlySomeone Else
WRITE THE OFFICIAL NAME YOU WANT ON THE N-WORD PASS*

First NameLast Name
IF GIFT: WHOM SHALL I SAY IT'S FROM?

First NameLast Name
GENDER: Please select the gender you most closely identify yourself. Optional

MaleFemaleMTF Trans WomanFTM: Trans ManNon-Binary
RACE & ETHNCITY: Select the option that most closely matches the race & ethnicity of the recipient of the N-Word Pass*

WhiteBlack (Darker Skin)Black (Lighter Skin)Hispanic or Latino (Darker Skin)Hispanic or Latino (Lighter Skin)East AsianSouth AsianMiddle EasternPacific IslanderNative AmericanMulti-Racial
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Please enter a valid phone number.
MESSAGE TO BURT: Describe in detail exactly why you want to use the N-Word Pass. Burt will announce message on livestream. *
BURT BRONX CONTACT INFO
- Burt Is Live: https://burtbronx.com/live
- Website: https://burtbronx.com
- Email: burt@burtbronx.com
- Send Audio TTS Message to Burt on Livestream: https://burtbronx.com/tips
- Schedule Private 1-on-1 Video Call:
- https://burtbronx.com/vc
BURT'S SOCIALS
- Discord: https://burtbronx.com/discord
- YouTube: https://burtbronx.com/youtube
- TikTok: https://burtbronx.com/tiktok
- Twitter (X): https://burtbronx.com/twitter
- Instagram: https://burtbronx.com/instagram
- Cameo: https://burtbronx.com/cameo
- Twitch: https://burtbronx.com/twitch
Should be Empty:

Official N-Word Pass Order Form by Burt Bronx

N-Word Pass Certificate - Design A

N-Word Pass Certificate - Design B

N -Word Pass Certificate - Design C