RAYS OF HEALING LIGHT

Gift Certificate Order Form

Please provide your contact, shipping, and recipient information: * means required field

	CONTACT INFORMATION
*First Name
*Last Name
*Street Address
Address (cont.)
*City
*State/Province	(2 letter abbreviation)
*Postal Code
Country
*Home Phone	xxx-xxx-xxxx
Work Phone	xxx-xxx-xxxx
Cell Phone	xxx-xxx-xxxx
*E-mail

	SHIPPING INFORMATION Fill in if you want gift sent directly to recipient. Otherwise, certificate will be mailed to you.
*First Name
*Last Name
*Street Address
Address (cont.)
*City
*State/Province	(2 letter abbreviation)
*Postal Code
Country
*Home Phone	xxx-xxx-xxxx
Work Phone	xxx-xxx-xxxx
Cell Phone	xxx-xxx-xxxx

	GIFT RECIPIENT INFORMATION
*Person's name to appear on gift certificate
*Animal's name to appear on gift certificate
*Home Phone	xxx-xxx-xxxx

*Type of session:	Animal Communication Energy Healing
*Length of the Animal Communication or healing session:	up to 30 minutes ($ 60 US) 30-45 minutes ($ 80 US) 45-60 minutes ($ 95 US)
OCCASION for GIFT
*What event is occasioning your gift?	**
** If "other", please describe the occasion:
If memorial (or honorarium), please give name of person or animal being memorialized (or honored):
*Date by which gift is needed:	,
PAYMENT OPTIONS
*Please indicate your form of payment:	PayPal Check or Money order
CERTIFICATE WILL BE MAILED WHEN PAYMENT IS RECEIVED. To Pay by Check
Make check or money order payable to:	Nedda Wittels
Mail to Nedda at:	9 Knollwood Circle Simsbury, CT 06070

To submit this form:
either
copy this page and send Nedda the information in email at: neddaw@sbcglobal.net
or
print out this page and mail it to Nedda Wittels at the above address.

Please print an additional copy for your records.