Gift Certificate Order Form

Specify Dollar Amount: $

Name you would like printed on the gift certificate:

Billing Address:		Shipping Address: (if different than billing)
Name		Name
		c/o
Address		Address

City		City
State		State
Zip code		Zip code
Phone		Phone
Email		Email

____Visa ____MasterCard ____American Express ____Discover OR _____Check made payable to: Twisted Tails

(Charges will appear on your credit card statement as Howell Drug Co)

Name on Card:________________________________ Card Number:_____________________________

Signature:___________________________________ Expiration Date:_________________________

How did you hear about us?_____________________________________________

Fax or Mail this Order Form to: Twisted Tails, 311 Teal Dr., Raeford, NC 28376, Fax (910) 875-8607