Gift Headquarters
Pre-Paid Gift Booklet Order Form
Print this order form first!  Then fill out the information below.
Fax the completed form to 1-847-718-1011
Company Name:                                          
Street Name: (No P.O. Box numbers please!)
Shipping Address:                                          
City State Zip Code
                                     
Operator Name: First Name
                                         
Last Name
                                         
Phone Number
                   
E-Mail Address (for confirmation of order)
                                         
Quantity Collection Point Value
      Sapphire   4,000 Enter the quantity of
      Opal     5,000 Pre-Paid Gift Booklets you need
      Topaz     7,000 from each collection.  
      Pearl     10,000
      Ruby     15,000 1,000 points is equal to one
      Emerald   20,000 ticket in value in most cases.
      Diamond   30,000
      Pewter   40,000 Please call Wallace Distributing
      Copper   50,000 at 940-325-1005 for pricing
      Bronze   75,000 of Pre-Paid Gift Booklets.
      Silver     100,000
      Gold     150,000
      Platinum   200,000
      Crystal   300,000
      Ivory     400,000
      Sterling   700,000
      Titanium   1,000,000
By signing this order form you give authorization to bill your operator account.
                                   
Operator Signature
FAX completed form to Gift Headquarters at 1-847-718-1011