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Gift Certificate Form
(Print Out)

BUYER'S INFORMATION

Name ___________________________________________

Address _________________________________________

City & State _____________________ Zip Code_________

Country __________________________________________

E-mail Address____________________________________

Day phone (____) _________________________________

Eve Phone (____)_________________________________

Would you like to be added to our mailing list?  myes   mno

 

RECIPIENT'S INFORMATION

Name ___________________________________________

Address _________________________________________

City & State _______________________Country_________

Zip Code (or Postal Code) __________________________

Day phone (____) _________________________________

Eve Phone (____)_________________________________

Would you like the recipient added to our mailing list?  myes   mno

 

CERTIFICATE INFORMATION  (please choose one):

m dollar amount $___________

m public class (list specific class name & date)

__________________________________________________

m Friday Night Dinner for ____ people ($32/person)

m store merchandise ______________________________

 

Mail gift certificate to (please check one):

m buyer   m recipient   m will pick up at The Natural Gourmet

 

What short message should we put on your gift certificate?:

__________________________________________________

Who is it from? (if other than just the buyer):

__________________________________________________

 

PAYMENT INFORMATION (please check one)

mCheck  mMoney Order   mVisa   mMC   m Amex

Credit Card # __________________________exp. date___________

CVV2 code (a three-digit security number located on the back of your credit card
by your signature) _____________________________________

Signature (required):______________________________________________