plaques.com Thermo Plaque Gift Certificate Order Form

FINE CUSTOM LAMINATED WALL PLAQUES
THERMO PLAQUE COMPANY INC.
14928 Calvert St., Van Nuys, CA 91411
CUSTOMER SERVICE (800) 245-7525

FAX (818) 988-8144
PHONE (818) 988-1080

Purchase a Gift Certificate

THERMO PLAQUE GIFT CERTIFICATE ORDER FORM
Print out and mail with check or money order, or Fax with credit card information

1. SOLD TO;
Enter the name and address of the person ordering the gift certificate:

Name

Street

City, State, Zip

Phone ( )

Fax ( )

2. SHIP TO: Enter the name and address of the person who will receive the gift certificate. Leave blank if you wish to have the certificate sent to the billing address.

Name

Street

City, State, Zip

Phone ( )

Fax ( )

3. Certificate Amount

$10

$20

$40

$60

$80

$100

______

4. METHOD OF PAYMENT

I have enclosed a Check or Money Order Made payable to Thermo Plaque Co., Inc. Check #_____________

Credit Card Account#

Please Circle

Expiration Date

Print name as it appears on card
_____________________________________

Signature (Required)______________________

IMPORTANT IF YOU HAVE ANY QUESTIONS, DO NOT HESITATE TO CALL CUSTOMER SERVICE
(800) 245-PLAK (800) 245-7525