Please Print Sender’s Name And Full Address In Orange Box Include Payment Information PAYMENT METHOD (U.S. FUNDS) VISA MASTERCARD AMERICAN EXPRESS DISCOVER CHECK # CREDIT CARD# AND INCLUDE CVC# (last 3 digits on back of card) SIGNATURE ON CARD EXP. DATE ____ / ____ ____________________________________________________________ STORE___________ CLERK_________________ DATE_____________ GIFT MESSAGE SHIPPING DATE CHRISTMAS THANKSGIVING OTHER DATE _____________ SHIP GIFT TO _________________________________________________________________ ADDRESS_____________________________________________________________________ CITY _____________________________________________________________________ STATE _____________________________________________________________________ ZIP _____________________________ PHONE #____________________________________ GIFT NUMBER SHIPPING DATE CHRISTMAS THANKSGIVING OTHER DATE _____________ CLUB PLAN NOV DEC JAN FEB MAR CHOOSE 3 MONTH GIFT NUMBER OR 5 MONTH CLUB SENDER’S NAME___________________________________________________________ ADDRESS_____________________________________________________________________ CITY ________________________________________________________________________ STATE _______________________________________________________________________ ZIP _____________________________ PHONE #__________________________________ # 16 SHIP GIFT TO _________________________________________________________________ ADDRESS_____________________________________________________________________ CITY _____________________________________________________________________ SHIP GIFT TO _________________________________________________________________ ADDRESS_____________________________________________________________________ CITY _____________________________________________________________________ STATE _____________________________________________________________________ ZIP _____________________________ PHONE #____________________________________ GIFT NUMBER CLUB PLAN NOV DEC JAN FEB MAR CHOOSE 3 MONTH GIFT NUMBER OR 5 MONTH CLUB PRICE $ _____________ SHIPPING $12.95 PER BOX $ _____________ (CANADIAN SHIPPING $23.95 PER BOX) TOTAL $ _____________
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