Custom Order Form

Complete this Custom order form for a luxurious gift basket designed by Mersene.  She will contact you with items and pricing. Baskets/GIfts range in price from $20 and up.  Make sure to be as detailed as possible when describing the receiver and their interests as well as any items you would like included.  If you prefer we take phone orders too.  Simply call (203) 557-9410

Your Name *
Your Name
Your Phone Number
Your Phone Number
Your Address
Your Address
Would you like to pick it up or have it delivered?
What is the delivery address if delivered?
What is the delivery address if delivered?