Single Russian Women Agency

lonely russian women

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Order Form

If you have any additional questions, please contact us by e-mail:

customercare@single-russian-women.ws

Please enter your details, fields marked with ** are required!

Phone Number**:

Fax Number:

E-mail**: only one/double check

Delivery/Mail Address
(Address, Zip etc):

Below please enter Cardholder's Address exactly as shown on Credit Card statement!:

Cardholder's Name as on card**:

Company name (if applicable):

Street Address**:

Zip /Postcode**: I have no ZIP code

City**:

State/Province/County:

Country**:

Select your creditcard type :

Visa

Mastercard

Eurocard

American Express

Discover

Diners Club

Carte Blanche

JCB

...

Type of Service
Price

Membership :

3 month membership

$ 21.00

6 month membership
$ 40.00

1 year membership
$ 65.00

Flowers :

Roses

Quantity
$ 5.00 each

Gifts :

Chocolate candy

$ 25.00

Perfume
$ 45.00

Delivery service :

Delivery of roses, chocolate or perfume

$ 19.00

Advertisement in newspapers ( in Estonia ) :

During 3 month in 3 newspapers

$ 14.00

During 6 month in 3 newspapers
$ 28.00

During 12 month in 3 newspapers
$ 56.00

Advertisement in newspapers ( in Ex-USSR cities ) :

1 time in 10 cities

$ 65.00

1 time in 21 cities
$ 130.00

2 times in 21 cities
$ 250.00

Translations :

Translations 600words

$ 18.00

Translations 1200words
$ 36.00

Translations 1800words
$ 54.00

Addresses :

1 Address

Lady ID number
$ 10.00

2 Addresses

Ladies ID numbers
$ 18.00

5 Addresses

Ladies ID numbers
$ 35.00

10 Addresses

Ladies ID numbers
$ 55.00

20 Addresses

Ladies ID numbers
$ 70.00

Quikmail service :

Number of letters
$ 6.00 each

Quikmail account :

account with 35 USD balance
$ 35.00

account with 50 USD balance
$ 50.00

account with 110 USD balance
$ 110.00

Additional Services
service descrition:

$

Important : In Secure Credit Card Entry Form you will be asked for your credit card type, number, expiration date and CVV2 number. CVV2 number is a 3 or 4 Digit Code After Card # on Back of Card, more information . If your card does not have a verification number, try another card or enter the number 000

Copyright � 1998 - 2004 by Single Russian Women Agency. All Rights Reserved

Please enter your details, fields marked with ** are required!
Phone Number**:
Fax Number:
E-mail**: only one/double check
Delivery/Mail Address (Address, Zip etc):
Below please enter Cardholder's Address exactly as shown on Credit Card statement!:
Cardholder's Name as on card**:
Company name (if applicable):
Street Address**:
Zip /Postcode**: I have no ZIP code
City**:
State/Province/County:
Country**:


Select your creditcard type :
		Visa
		Mastercard
		Eurocard
		American Express
		Discover
		Diners Club
		Carte Blanche
		JCB

	Membership :
	3 month membership		$ 21.00
	6 month membership		$ 40.00
	1 year membership		$ 65.00

	Gifts :
	Chocolate candy		$ 25.00
	Perfume		$ 45.00

	Delivery service :
	Delivery of roses, chocolate or perfume		$ 19.00

	Advertisement in newspapers ( in Estonia ) :
	During 3 month in 3 newspapers		$ 14.00
	During 6 month in 3 newspapers		$ 28.00
	During 12 month in 3 newspapers		$ 56.00

	Advertisement in newspapers ( in Ex-USSR cities ) :
	1 time in 10 cities		$ 65.00
	1 time in 21 cities		$ 130.00
	2 times in 21 cities		$ 250.00

	Translations :
	Translations 600words		$ 18.00
	Translations 1200words		$ 36.00
	Translations 1800words		$ 54.00

Addresses :
1 Address	Lady ID number	$ 10.00
2 Addresses	Ladies ID numbers	$ 18.00
5 Addresses	Ladies ID numbers	$ 35.00
10 Addresses	Ladies ID numbers	$ 55.00
20 Addresses	Ladies ID numbers	$ 70.00

	Quikmail service :
	Number of letters	$ 6.00 each

	Quikmail account :
	account with 35 USD balance	$ 35.00
	account with 50 USD balance	$ 50.00
	account with 110 USD balance	$ 110.00