Amazon Casino is safe, secure and fast. Place your order now. A $25.00 (USD) purchase will entitle you to 25 Chips, which will be deposited directly into your account. Come and join the thousands of players world-wide at 21 Casino now. Try Amazon Casino for yourself! It's fast, fun, simple, and safe!

The minimum order is $19.95. We accept Visa and Master Card.


Read INSTRUCTIONS below before completing!!!

Instructions
To place an order, simply complete the form below. You must have a casino account opened prior to placing an order using this form.

To open a free casino account click here if you have not already done so.

Complete the entire form and your account will be updated with Chips. Make sure your email address is complete. You will receive an automatic email confirmation of your order.

GOLD Club Members
GOLD Club Members need only to complete the areas that have asterisks (i.e. *Last Name*). Enter only the LAST FOUR DIGITS of the credit card used for prior purchases.

DO NOT ENTER A GOLD CLUB NUMBER IF YOU HAVE NOT RECEIVED ONE FROM US.

If you have ordered from us in the past and wish to become an exclusive GOLD Club Member, please send email to webmaster@CasinoMail.com with your full name and address. We will send your GOLD Club number by email.



NOTICE
You must use the billing address associated with your credit card (i.e, where your statements are mailed!). We will send winnings only to this billing address which we verify with your bank.
Name and Address
*Last Name*
*First Name*
Address
City
State/Province
Zip/Postal Code
Country
*Telephone*


Casino Information
*Acctname*
*Password*


Gold Club Number
*Gold Number*
(Leave BLANK if NO GOLD NUMBER


E-mail Address
*E-mail Address*
MUST ENTER EXACT EMAIL to receive order


Payment Information
*Amount of Purchase* $ U.S. Dollars
(Minimum Order $19.95 USD)
*Card Number*
*Exp Date*
Name of Issuing Bank
Card Type
*Exact Name Printed on Card*
Submit Order

I certify that I am authorized to use the credit card above. I authorize you to verify the order with the bank. I give you permission to provide information to the proper authorities in cases of fraud. I understand that this order request may be traced to protect the cardholder from fraud.

WARNING
Please WAIT after clicking below. Your order may take one or two minutes to complete. Do not click more than once.





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