|
Please select the quantity and total the amount in the column
provided. Include a check, money order, or credit
card information and we will send you a receipt with the gift
certificate to the address as indicated on the order form. If
you have any questions please do not hesitate to contact our
office at 703-752-4078 and ask to speak with Tracey .
| Type |
Price |
Quantity |
Total |
| Massage or Reflexolgoy 1 hour |
$ 90 |
|
|
| Massage 1 1/2 hours |
$ 130 |
|
|
| Massage 1/2
hour |
$ 50 |
|
|
| Hot Stone/Raindrop 1 1/4
hours |
$ 130 |
|
|
| Hot Stone/Raindrop 1 1/2
hours |
$ 145 |
|
|
These
prices are all inclusive. No additional fees. Please give us
the address you would like your gift certificate and receipt
mailed to:
| Recipient of Gift Certificate: |
Your Information: |
| Name: |
Name: |
| Address: |
Address: |
| City/State: |
City/State: |
| Zip: |
Zip: |
| Phone: |
Phone: |
| |
Email: |
| |
Can we leave a message
at this number? Yes / No |
| Ship Gift Certificate
to above address? Yes / No |
Ship Gift Certificate to
above address? Yes / No |
If this is a special occasion, please indicate
a personalized greeting you would like to include on the
gift card.
Please
include your phone number and email for any questions we may have to
clarify your order. If this is a surprise gift and you prefer no
message to be left at this number, please indicate by circling a
response.
Payment
Information
Check or Money Order enclosed and made payable to: Tri Therapeutic Massage
Credit Card Information. Please circle: MasterCard/Visa
Credit Card Number:______________________________ Exp
Date:___/___/___
CVV (3 digit code on back of card): ________________________________
Name as it appears on the Credit
Card:__________________________________
Cardholder's
signature:_______________________________________________
Print
out, complete form
and mail to: Tri Therapeutic
Massage 11250 Roger Bacon Drive, Suite 5, Reston, VA 20190
for
office use:
_______ GC #
_______ Date sent _______ initials
rev.
11.2.04trimassage.com
|
