BBIM Gift Certificate Order Form To order one or more BBIM Gift Certificates, print out this order form, complete it, and send it and your check or credit card information to the address at the bottom of the form. We will mail you the BBIM Gift Certificate(s) as soon as we receive the order! Your Name(s): Address: Address 2: City: State & Zip: Phone: _______________________________________________________ ($50 minimum per certificate; certificates are issued in $50 or $100 values only. When your order exceeds $100 we provide multiple certificates for $50 or $100 - for example, for a $300 order we will provide three $100 certificates.) Add processing fee: $5 Total Amount: $_________________________ Card number: __________________________________________________________ Expiration Date: __________________ 3 digit verification number_____________ I agree to pay the above amount in accordance with my cardholder's agreement. Signature: _________________________________________________________ Amount of first certificate: $________________ ($50 minimum) Recipient(s) name(s): _______________________________________________________________ Donor's Do you want to fill in the donor's name yourself? Yes No Where do you want the BBIM Gift Certificate(s) sent? _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ On the reverse or a separate sheet, please provide the above information for any additional BBIM Gift Certificates you are ordering. Mail to: |