Gift Certificate Form

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· Gift Certificate Form Your name _____________________________________  Your email _____________________ Address1 ______________________________________ Address2  ______________________________________ City, ST.  ______________________________________ Zip  ______________________________________ Tel:  ______________________________________ Credit Card Type  _______________ Credit Card Number  ______________________________________  Expiration Date  _________________________  Amount of Certificate _____________________ Recipients Name  ______________________________________  email  ___________________ Address1  ______________________________________ Address2  ______________________________________ City, ST.  ______________________________________ Zip  ______________________________________ Tel:  ______________________________________ Message to recipient:  ______________________________________ ******* Print This Page ******* Fax to 860-871-6963 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - -  Please print first, then fill out all the information below and fax to the number above. The Gift Certificate will be sent first class US mail within 24 to 36 hours. Please allow 5 to 7 business days for delivery.