First Name Last Name Street Address Address (cont.) City State Zip Code Phone Number E-mail Small Gift Baskets 0 1 2 3 4 5 $15.99 each shipping included Deluxe Gift Baskets 0 1 2 3 4 5 $20.99 each shipping included Please send your check or money Order to: JS Diamond 1736 E. Charleston Blvd Las Vegas, NV 89104-1952I