| Please mail the completed form
to: Chincoteague Natural History Association P.O. Box 917 Chincoteague, Va. 23336 Phone/Fax 757-336-3696 Gift Certificates Merchandise in Our Sales Outlet or Tour Bus Tickets |
|
| Name: | _________________________________________________ |
| Address: | _________________________________________________ |
| _________________________________________________ | |
| _________________________________________________ | |
| Phone Number: | _________________________________________________ |
| E-mail Address: | _________________________________________________ |
| Method of Payment | |
| Check/money Order: | _________________________________________________ |
|
Credit Card Number: (Mastercard or Visa) |
_________________________________________________ |
| Card Expires: | _________________________________________________ |
| Amount: | _________________________________________________ |
| Your Signature: | _________________________________________________ |
| Mail To | |
| Name: | _________________________________________________ |
| Address: | _________________________________________________ |
| _________________________________________________ | |
| _________________________________________________ | |
| From: | _________________________________________________ |
| Gift Certificate Number:
____________________________ |