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Fillable Printable Gift Certificate Request Form

Fillable Printable Gift Certificate Request Form

Gift Certificate Request Form

Gift Certificate Request Form

Gift Certificate Request Form
Step 1: Please circle the therapist you would like to purchase your gift from.
Jennifer Harris
Donna Grady
Step 2: Indicate the type of certificate you would like.
30 minute massage, $35 (after 1/1/08, $40)
60 minute massage, $60 (after 1/1/08, $65)
90 minute massage, $80 (after 1/1/08, $85)
Specific dollar amount, please specify:________
Step 3: How would you like to obtain your gift certificate(s)?
Pick up: Please stop back tomorrow or leave contact information to arrange a time.
Your name and phone number:____________________________
Or
Have it mailed: Your mailing address: ______________________________
______________________________
______________________________
Step 4: How would you like to pay?
Visa/MC Card#______________________Exp.Date:_____
Zip code of billing address:_______
Print name:__________________________
Signature:___________________________
Cash or Check can be left when you pick up certificate. If you are having it mailed,
please leave payment now. Please make checks payable to Ray of Light.
Step 5: How would you like your certificate filled out?
To:____________________________________
From:__________________________________
*Additional gift certificates? Please use back of sheet.
*Please leave blank if you prefer to fill it out yourself.
Please mail forms to Ray of Light Massage, 110 S. Wisconsin St., Port Washington, WI 53074,
or if you are in our waiting room, slide completed form (envelopes available behind forms)
under the door just to the left of the couch. This door is locked and your information will be
safe there. Forms may also be left with Dr. Spaude, if he is present.
Thank you for your purchase!
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