Eos Salon

Gift Certificate Request Form
( * ) Required Fields

Please Enter Information Exactly As You Wish It To Appear On The EOS Salon Gift Certificate

CERTIFICATE: RECIPIENT AND DOLLAR VALUE

This certificate entitles

*First Name:

*Last Name:

*Certificate Amount:

GIFT CERTIFICATE:

FROM:
(70 character max) e.g. Your Loving Husband, or The Smiths, John & Susan

MESSAGE:
(100 character max) e.g. Relax & Enjoy, Happy Birthday, Thanks For Everything

SHIPPING:

*Method:

	US Postal Service

DELAY SHIP DATE: (OPTIONAL)
/ /
Note: leave this BLANK if you want us to ship this promptly; but if you want us to delay shipment, please indicate the future date for us to SEND the gift (not the date your recipient will receive it).

PLEASE INSTRUCT US WHERE TO SHIP THIS CERTIFICATE. (no APO/FPO, no PO Boxes, no non-US addresses)
* First Name:
* Last Name:
Company Name (if to a business):
*Street Address 1:
Street Address 2: Use for APT #, Floor, Bldg, Suite, etc.
*City:
*State:
*Zip:
*Country:
Phone #: - - Ext:
* Zip
* Country
* Your phone #:
* How did you hear about us

Phone #: - - Ext: