Gift Certificate Ordering Information
If you prefer to not order online or would like to pay by check or money order, you can print this form and mail or fax it to us. Please complete all required fields. You can also call us.

The Order Form: (*=required)

*Your First Name

*Your Last Name

*Address

*City

*State/Province

*Zip Code

*Country

*Email

*Day Phone

Evening Phone

*Gift Amount


Gift Information

*Certificate Made Out To

*Make Signed From

Occasion (if any)

Mail to Name

Address

City

State/Province

Zip Code


Credit Card Information

Type of Credit Card

Credit Card Number

Expiration Date  

Card ID Number

help if visa,master card

Please enter the following information as it appears on your credit card's billing address. Please fill in ALL of the following, as they are required to secure your order

copy my information

Name on Card

Address

City

State/Province/Territory

Zip/Postal Code

Country






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A Georgian Manner Bed Breakfast • 29055 Evans Rd. • Logan  • 1 800 606 1840