Gift Certificate Order Form (1hp702ai)

GIFT CERTIFICATE Request FORM

Please complete all information in this section.
Your Email Address
Your Telephone #
Your "nick" Name to go on the card
Your First Name "real" first name
Your Last Name
Please fill In the following lines as you would address an envelope. (Use as many lines as needed - up to 5.)
Address Line-1
Address Line-2
Address Line-3
Address Line-4
Address Line-5

Note - We have a MONEY BACK GUARANTEE.
If she doesn't like it, then we will return your money to you less the S&H fee.
If returned after 30 days, there will be a 20% restocking fee.

Gift Certificate Recipients Information

First Name
Last Name
"nick" Name	<to go on the card
Please fill In the following lines as you would address an envelope. (Use as many lines as needed - up to 5.) To be used as Ship-To Address
Address Line-1
Address Line-2
Address Line-3
Address Line-4
Address Line-5
Email Address - If you know it or if she has one.
Telephone # - If you know it.
Notify by ...	Email Regular Mail - Send Color Samples and Catalog Both Email and Send Color Samples and Catalog
Reason for Gift (Birthday, Anniversary, Christmas Gift, I love you, etc. — to be mentioned in our notification)
Maximum Amount of Gift Certificate	in US Dollars You will give your credit card information on our secure store site. After you click on the submit button you will be re-directed to the "store". Select the Gift Certificate "product". Don't worry about information for the shipping address. You've already given us this information.

I have the following questions or comments or ... additional information to go on card.

PRIVACY Statement: We never sell or give out your name or any information you give to us. Period. End of Statement.

	Click the Submit Button — and you will land at our Secure STORE. Select Gift Certificate and fill in your Credit Card Information.
	WARNING: If you click here ALL the information, including your name, address, etc. will be cleared. If you simply want to change a few items you checked, go back up to the area where you want to make the changes and just change that information instead of starting all over. OR . . . Want to go back?

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GARLAND DRAKE
1001 West 17th Street, Suite S
Costa Mesa, CA 92627-4512
USA

Telephone
1·800·426·9197
- or - 1·949·722·2277
Email Charlotte or Raymond
www.GarlandDrake.com