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!
State & Zip:
($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): _______________________________________________________________
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.