Botanical Lampshades
95 Foss Flats Road, N. Sandwich, NH  03259 / Phone 603-284-7468

GIFT CERTIFICATE ORDER FORM
print and mail to above address

*Please Note*
All Gift Certificates are recorded / May not be redeemed for cash

Gift Certificates can be made for ANY amount with a minimum of $25.00. You will be charged for that amount only, no shipping charge is added. If you need to order more than one certificate, you will need to fill out a form for EACH individual certificate and your bill will be combined if needed.

If you have any questions feel free to contact me at flowershades@webtv.net.

 Your Name and Information:

Name: ________________________________ 
Street:  ___________________________________________________________
   City:  _____________________________ State: _____ Zip: _______________
Phone: ( ____ ) ______________________

Gift Certificate Receiver Information:

Please forward a Botanical Lampshades Gift Certificate to below individual in the amount of:  $ __________.

Name: ________________________________ 
Street:  ___________________________________________________________
   City:  _____________________________ State: _____ Zip: _______________
Phone: ( ____ ) ______________________

Enclosed is my check or money order in the amount of: $___________.

Please forward order form with payment to above address.  Thank you for your order!