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Plan C - Holiday Care Plan

A care package sent for 4 holidays (Halloween, Valentines, Birthday, Easter) to perk up their year. These gifts feature holiday themed food, supplies, novelty holiday gifts, and a game of the month or Blockbuster card. Be sure to note Birthday month in the Additional Instructions portion of your order form.

*Required **Additional Cost

* $49.99 per holiday (billed each shipment)

	Include Gift Card at No Extra Cost
	Gift Card Reads:
	Include Balloon Bouquet (6 latex & 1 themed mylar), $9.99
	-- delivery or pick-up orders only/no shipping --

Billing and Contact Information:

*Name:

*Phone:

Company:

Fax:

*Address:

*E-mail:

*City:

*State:

*Zip Code:

Shipping Information Check to use same information as above:

*Name:

*Address:

Company:

Phone:

*City:

*State:

*Zip Code:

Delivery Date:

**Next Day 2 Days Within 1 week Other

Payment Method:

Credit Type:

Visa MasterCard American Express

Card #:

Expiration Date:

3 Digit Code:

Billing Zip Code:

Plan C - Holiday Care Plan

Billing and Contact Information:

Payment Method:

Additional Instructions: