Gifts Order Form

To send a gift, please fill out and submit the following form.

You will be billed by 'Anastasia Contact Club' and this name will appear on your credit card statement.

Enter the ID of the lady you want to send the gift(s) to: ID#

Please select the gift(s) you want to send:

Flowers

11 roses ($80) 5 roses ($40) 5 carnations ($25)

Chocolates

Large box of Chocolets ($30) Small box of Chocolets ($20)

Champagne

A bottle of champagne ($30)

Toys
see Gift Toys
for samples

Item#01-Winnie the Pooh ($45)
Item#02-Mickey Mouse ($45)
Item#03-Cute Puppy ($45)
Item#04-Puppy Couple ($40)
Item#05-Donald Duck ($45)

Item#06-Bunny with Carrot ($40)
Item#07-Scholar Teddy ($40)
Item#08-Pink Teddy ($40)
Item#09-Baby Mouse ($40)
Item#10-Wyle E. Coyote ($50)

We can attach to the gift (at no additional price) a small card with a message from you. If you want a card, enter the message in the field below and we will print it on the card. If you don't want a card, leave the field below blank.

Your first name:
You last name:
Your email:

Any comments you may have for us:

PAYMENT DETAILS
Type of credit card:
Cardholder name:
Credit card number:
Expiration date:

By submitting this form you agree to pay the total price of your order.