Gift Certificate Form

Instructions:

Please fill out the following sections completely. We will custom print each certificate using the information you provide. The donor section should contain information about you. In the recipient section, please provide information about the individual you wish to give this certificate. Should you have questions regarding formatting or information placement, please see the Gift Certificate image or e-mail Heather Bowden.

Gift Certificates are available in denominations of $5, $10, $25, and $50.

Information about the Donor:

Contact Name:
Street Address:
City:
State:
Postal/Zip Code:
Country:
E-mail:

Type of Certificate?
Gift
Bereavement
Donor

Payment Method?
I will send a Check to the address provided below;
I will send a Money Order to the address provided below;
I will provide my Visa/MasterCard information by calling the phone number provided below;
I will use PayPal via the link provided below.

Gift Certificate Recipient:

Name (to appear on Certificate):
Street Address:
City:
State:
Postal/Zip Code:
Amount:
E-mail:
Donation Made By:

Comments?

The information provided in the gift certificate section will be used to create and send a custom printed certificate to the above named individual(s). If you would like to include a personalized phrase, please feel free to do so in the Comments box in the section above.

To complete your request:

Please fill out this form completely, including your e-mail address. The requested information will allow us to contact you in the event of questions concerning your certificate order.

Visa Logo MasterCard Logo When your check or money order arrives we will ship your certificate. To pay by credit card, fill out and submit the order form to process your request. Then call 972-208-2470 between the hours of 8AM - 8PM CST to supply your credit card information.

Should you prefer to make your donation using PayPal, we have provided a link for your convenience.

If you wish to pay by check or money order, when your form is complete, please submit it (you may wish to print a copy for your records) and mail a copy, along with your check or money order, payable to LABMED, to:

LABMED, Inc.
3941 Legacy Drive, Suite 204, #A115
Plano, TX 75023

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