Amadeus Spa Online Gift Certificates Order Form

Fill in the information below to purchase an online certificate.

1. Enter the dollar amount and any desired services below.
(6.0% sales tax will be added to all orders)

*Gift Certificate dollar amount	$
Gratuity dollar amount (optional)	$

2. How would you like the gift certificate personalized?

Message (optional)

3. Where would you like to have the gift certificate delivered?

	Send to recipient address
	Send to billing address
	Pick up at Amadeus Spa

4. Address information

Purchaser (billing information)		Recipient
*First Name		*First Name
*Last Name		*Last Name
*Street Address		Street Address
*City		City
*State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming	State	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
*Zip		Zip
*Email Address		Email Address
* Telephone		Telephone
*required

5. Credit Card Information

Name on Card
Card Type	Card Number	Expiration
Visa Mastercard		01 02 03 04 05 06 07 08 09 10 11 12 / 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

*CCID:   As an added security measure, we ask that you enter the last 3 digits on the back of your credit card, on or near the signature panel, called the CCID. See sample on right.