PLEASE PRINT THIS FORM OUT AND SEND IT WITH YOUR PAYMENT TO THE ADDRESS LOCATED AT THE BOTTOM OF THIS PAGE .

Certificate Orderform

Date:_____________  
To: Shipping Address (if different):
________________________________ __________________________________
________________________________ __________________________________
________________________________ __________________________________
Name of Person Ordering:_________________________ Day-time Telephone#:_________________
Telephone Order:____ Fax:____ Web:____ Email:____ Mail:____ In Person:____

Vacation Certificates
Item ID Quantity Unit Cost
Total
VC1 50 $1.20ea
VC2 100  $1.00ea
VC3 250   $0.80ea
VC4 500 $0.70ea
VC5 1000  $0.60ea
Shipping & Handling - Flat Rate is $10.00
 
$500 Casio Cash Certificates
Item ID Quantity Unit Cost
Total
CC1 50 $1.20
CC2 100  $1.00ea
CC3 250   $0.80ea
CC4 500 $0.70ea
CC5 1000  $0.60ea
Shipping & Handling - Flat Rate is $10.00
 
$1000 Gift Certificates
Item ID Quantity Unit Cost Quantity
Total
GC1 10 - 99 $5.00
GC2 100 - 249 $4.00
GC3 250 - 499 $3.00
GC4 500 - 999 $2.50
GC5 1000 + $1.50
Shipping & Handling is Free

Please print here the Name that you would like to appear on your Certificates.

 

Paid by __Cashier Check__Cash__Money Order       Order Total: $____________

All Certificates will be shipped within 24 hours by Priority Mail after payment is received.

Signature: X_______________________________

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®MiThyme Services
932 NE Maynard Rd. Suite 103
Cary, NC 27513