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Billing Information:
Note: Must match address on your credit card statement!
Name:
*
Company:
Address 1: (street address)
*
Address 2: (apt #, suite)
City, State ZIP:
*,
*
*
Phone: *
Email: *
Quantity:
(Please choose "Send to your billing address" if over 1)
Credit Card Information:
Number: *
Type: *
Expiration Date:
*
CVV: *
(3 digit code on back for Visa/MC/Disc or 4 digit code on front for AMEX)
Promotional Code:
If you received a code, please enter it here:
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Shipping Information:
Send to your billing address (you can deliver the gift card)
Send to: (we will send with your greeting)
Name:
Company:
Address 1: (street address)
Address 2: (apt #, suite)
City, State ZIP:
,
Gift Card Information:
If we are sending this card for you, we will include a note with the following information.
Gift From:
(ex, "Bobby, Sally and Dad", "Your Friends at XYZ Widget Company")
*
Gift To:
(ex, "Mom", "Mr. McFeely and the rest of the Speedy Delivery team")
*
Gift Message:
(ex, "Happy Holidays!", "Happy Birthday!", "Thanks for a Great Year!")
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