Delivering Form
Name
Street Address
City
Specify other city
Contact Phone
E-Mail
Name
E-Mail
Address
City
State
Country
Zip/Postal Code
Phone
Fax
No
1 rose ($10.00)
5 cloves ($25.00)
5 roses ($50.00)
9 roses ($90.00)
15 cloves ($75.00)
15 roses ($150.00)
 No
White vine "Liebfraumilch" ($60.00)
Red Bordo "Baron de Lestac" ($60.00)
Seagram's gin ($50.00)
Martini Bianco ($50.00)
Martini Brut ($50.00)
Henessy ($50.00)
Jan de Ville ($50.00)
Chinon ($50.00)
No
Chocolate ($20.00)
 No
Lovely toy ($50.00)
Huge lovely toy ($75.00)
No
Ear-Rings ($25.00)

 No
Perfume ($49.95)
Other(please specify) 
Money to spend  USD

  Message with gift
Print message on a beautiful card (+$3)
Translate the message into Russian (+$2)
    attached
  E-mail photos to photo@amenint.com.
Take a picture when deliver and e-mail back to me (+$5)(with addressee's Ok of course)
 Additional instructions/comments: