MAILFORM FOR GIFT CERTIFICATE PURCHASE
If you are purchasing a Gift Certificate and want to pay for it by post, please complete this form and post to CLW.
This form is also available as a Word Document.
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Your Name: |
| Your Email Address: |
| Member of CLW: Yes or No |
| Name of nominated individual for the Gift Certificate: |
| Email address of the individual: |
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Your Telephone (to confirm details if required) |
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Postal Address of individual:
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Payment Method: Online Secure Credit Card ( ) Cheque ( ) Money Order ( ) Credit Card by post ( ) |
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Credit Card - Card Type: Visa ( ) Mastercard ( ) Bankcard ( ) |
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Card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
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Expiry: Month: Year: 20 |
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Name on Card: |
| How did you find out about the Centre? (please
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