GIFT CERTIFICATE ORDER FORM

( * Denotes Required Field)

	Purchaser
	*First Name:
	*Last Name:
	*E-mail Address:
	*Confirm E-mail:

	*Day Phone Number:
	Alt Phone Number:

	Address:
	City:
	Province/State:
	Country:
	Postal Code/Zip Code:

	*Gift Certificate Amount:	$
	Total Plus GST:	$
	Payment Options:**
	Credit Card is in the following name:
	**A Stampeder Representative will contact purchaser directly to confirm payment option.

	Gift Certificate to be sent to...
	First Name:
	Last Name:
	Address:
	City:
	Province/State:
	Country:
	Postal Code/Zip Code:

	*Day Phone Number:
	Alt Phone Number:
	*E-mail Address:
	*Confirm E-mail:
	Comments: