Gift Certificate Form

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Instructions: Complete the information below and click the "Submit" button. A screen will be returned asking you to enter the amount of the gift certificate. When you click on "Submit" again, it will return a screen that will request your credit card payment information. If you prefer to pay by check, you can print out this page and mail a check to:
Shakti Chionis, PO Box 864, Coupeville WA 98239. Make checks payable to Shakti Chionis.

Gift Purchaser:

First Name:
Last Name:
Address:
City:
State:
Zip:
Telephone:
E-mail:

Gift Recipient:

First name:
Last name:
Address:
City:
State:
Zip:

Gift certificate valid for 1 year from date purchased.

Send to:

Purchaser
Recipient

 

Please indicate who the gift is from in the message box below and add any message you would like to send to the recipient along with the certificate: