Untitled Document

Order Form

CDB Inc.

First Name:

Last Name:

Address:

City:

State:

Zip/Postal Code:

Country:

E-Mail Address:

Please write me a brief .description .of .your .beloved. one.

Any special purpose behind this letter.*

etc:

Beloved's Nickname: *

Beloved's E-Mail-Address:*

(If you wish me to send the letter for you)

* all optional

One page (aprox. 40 lines) Love Letter $50

Credit Card Type:

Expiration date: mm/yy

Cardholder Name:

Cardholder Number: