gift card ordering form

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 Ordered by:
First Name:
Last Name:  
Address:
Apt, Suite:
City: State:   Zip Code:
Phone Number:  
Email:
Ship GIFT CARD to: check box if shipping address is same as billing address. We DON'T ship to P.O Box numbers. 
First Name:
Last Name:
Address:
Apt, Suite:
City: State: Zip Code:
Phone Number: *NUMBER IS REQUIRED FOR SHIPPING - ORDER WILL BE DELAYED IF MISSING
 

add a gift message: *REQUIRED FOR GIFT CARDS 

      Product
  Name / Code

 

Quantity

 

Product Description

 

    Price Each

Enter gift card any denomination 

Total
Amount

 

giftcard-100 GIFT CARD - for use at jcwyatt online gift store and model site merchandise at www.jaceywyatt.com

Fill-in Total:
* Shipping (use chart below):
Sales Tax(CT=6%):
TOTAL AMOUNT:
Credit Card: allcreditcards.gif (6168 bytes)

Visa MasterCard  Discover Card  American Express

Name on Card:
Credit Card Number:  
Exp. Date:
Street Address Card is billed to:
Zip Code Credit Card is billed to:

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GIFT CARD Shipping- only

Ground Service Second Day Service Next Day Service
3 to 8 business days 2 business days (by 5 p.m.) Next day by 5 p.m.
FEDEX sample rates $5.95* $14.95-19.95* $26.25-29.95*
*Most areas. All shipping costs are estimated here. Actual amount will be on Invoice with customer notification. 
All rates apply to the 48 contiguous U.S. states only. Call for AK, HI, PR. Orders ship Monday through Friday; signature required for most deliveries. All prices subject to change without notice. For Saturday rates delivery at $15 extra charge is applied to account, Questions and information please call  203-481-0001for shipping costs.


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