Heaven on Earth Spa & Wellness Centre

Gift Certificate Order Form

Name:______________________________________________________________________

Company Name (if applicable):___________________________________________________

Address:____________________________________________________________________

Suite:_______________________________________________________________________

City: _______________________________ Postal/Zip Code: __________________________

Province/State:________________________ Country: ________________________________

Daytime Phone: (____ ) ___________________ Evening Phone: (____)___________________

Fax Phone Number: (____) ________________

RECIPIENT INFORMATION

Name:_____________________________________________________________________

Company Name (if applicable):___________________________________________________

Address:____________________________________________________________________

Suite: ________________

City: _______________________________ Postal/Zip Code: __________________________

Province/State:________________________ Country: ________________________________

Daytime Phone: (____ ) ___________________Evening Phone: (____)____________________

GIFT CERTIFICATE INFORMATION

Package Treatment NAME or Dollar Value:________________________________________

Certificate to read:

To: ________________________________________________________________

From: ______________________________________________________________

YOUR Remarks: ___________________________________________________________________________

___________________________________________________________________________

Price: __________________________

G.S.T (7%): ______________________ONLY IF PACKAGE

Total: __________________________

DELIVERY INFORMATION (Please Tick the Appropriate Box)

___ Send to Purchaser (additional Charges) ___ Send to Recipient (additional Charges)

___ Spa to Mail (additional Charges)___ Spa to Courier (additional Charges)

___ Purchaser to Pick up ___Purchaser to Send Courier

___ Leave at Spa for Recipient

PAYMENT INFORMATION

PLUS SHIPPING & HANDLING CHARGES WHERE APPLICABLE

___ Visa ___MasterCard ____ Amex (Please Tick the Appropriate Box)

Cardholder Name: ______________________Card #: ___________________________

Expiry Date: _____/_____

Signature:_______________________________________________________________

Telephone 905. 372. 0557 or 1. 866. 372. 0557: Fax: 905. 372. 5965

Thank You for allowing us to be of Service to you. Wishing you all the Wellness in Life.