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Printable Gift Certificate Order Form

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Printable Gift Certificate Order Form Powered By Docstoc
					                 Appalachian Rider Education Program
                                                                                          Date Rec.
                                                                                           Ca Ck CC
                                                                                             Amt. $
                                                                                      Verification #
                                                                                       Date Issued

 Buyer’s Information (From):
 Name (first):                           (middle):                          (last):
 Home/Cell Phone:                      Times:            Alt. Phone:                        Times:
 Date Gift Certificate is requested to be sent by:
 Address:
 City:                                   State:                           Zip Code:
 Name(s) that will appear on the Gift Certificate as “From”:
 Message on the Gift Certificate (Optional):

 How did you learn about A.R.E.P.? (Please circle/ list all that apply)
   Friend, Television, Magazine, School, Newspaper, D.M.V., Previous Graduate of this Course,
   Online (Please list site):
   Other (Please list):
 Recipient’s Information (To):
 Recipient’s Name (first):                  (middle):                (last):
   (Please put name of organization above if buying for raffle or charity event)
 Gift Certificate Information:
 Please circle the Gift Certificate Theme below:
           “Happy Birthday”              “Merry Christmas”                “Happy Holidays”
           “Congratulations!”            “Graduation”                     “Thank You!”
           “Happy Mother’s Day”          “Happy Father’s Day”             “To Someone Special”
 Other (Please list a theme/ title of your choosing):
 Course Information:
                        (Please Circle a Course with any discount applicable below)
         Basic Rider Course           Experienced Rider Course               Advanced Rider Course
               $225.00                             $100.00                              $100.00
   Military or Student Discount*       Military or Student Discount*         Military or Student Discount*
             $25.00 Off                          $10.00 Off                            $10.00 Off
Please enclose a check or money order for the appropriate registration fee at least TWO weeks prior to the
                                 requested Gift Certificate send date.
   Mail this form and check payable to:               For Questions, and/or More Information:
        Appalachian Rider Education                             Call: (423) 878-4969
                  P.O. 3232                                Email: AREP4U@Yahoo.com
           Bristol, TN 37625-3232                     Go Online: www.AppalachianRiderEd.com

   Once we have received your Gift Certificate Order Form and money we will go to work
   creating a personalized Gift Certificate for your special someone. Then we will mail the
    Gift Certificate to the listed mailing address above, along with a personalized Student
       Registration Form and an Information Sheet about Appalachian Rider Education
                                             Program.

				
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