|
Information: |
| Contact
Name: |
______________________________ |
| Phone
Number: |
______________________________ |
| Email: |
______________________________ |
|
Information
that will appear on the Certificate: |
| Recipients
Name: |
______________________________ |
| Amount
or Treatment: |
______________________________ |
| From: |
______________________________ |
| Would
you like this Certificate: |
|
E-mailed: |
_____ |
Certificate
will be e-mail to you within 2 business days |
|
Delivered: |
_____ |
$15
will be charged for delivery, 1-2days (within Canada) |
|
Mailed to
you: |
_____ |
1 Week
(within Canada) |
| If
you chose regular mail please complete the following: |
| Name: |
______________________________ |
| Street
Address: |
______________________________ |
| City: |
______________________________ |
| Postal
Code: |
______________________________ |
| Country: |
______________________________ |
| State
or Province: |
______________________________ |
|
Comments: |
________________________________________________
________________________________________________
________________________________________________
________________________________________________
|