Order Form
Fill Out the form below to send a gift certificate to your special someone for any occasion.
Purchaser Information
Full Name        
 
Address        
City        
State        
Zip        
 
E-Mail Address        
Phone Number        
 
 
Please Select any of the Following Packages...
      The VENUS Spa Package $285
      The ASTARTE Spa Package $235
      The HERA Spa Package $220
      The ZEUS Spa Package $195
      The APHRODITE Spa Package $95
      The BRIDE Spa Package $255
      The GROOM Spa Package $145
      $50 Spa Gift Certificate
      $75 Spa Gift Certificate
      $100 Spa Gift Certificate
      $250 Spa Gift Certificate
      $500 Spa Gift Certificate
      $Spa Gift Certificate
 
Credit Card Information
Name on Card
Type of Card        
Other?        
Number        
Expiration Date  /    (mm/yy)        
 
           
Name to Appear on Gift Certificate
if Different Than Above
 
Full Name        
Address        
City  
State  
Zip  
Personal Message to appear on Gift Certificate (Happy Birthday, etc.)
 
Please Check Here if You Would Like Your Gift Certificate to be Sent in the Mail
   



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