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