GIFT HEADQUARTERS
OPERATOR PRIZE CATALOG ACCOUNT APPLICATION

Fill out the information below. Then press the PRINT button. Once you have printed the form be sure to sign it to authorize Gift Headquarters to establish your account. Fax the signed form to 1-847-718-1011. Your application will then be processed and your new account information will be e-mailed to you.

The information on this application will be used for payment of ordered merchandise.


Company Name: 
First Name: 
Last Name: 
Billing Address: 
City: 
State: 
Postal/Zip Code: 
Company E-Mail Address: 
Phone Number: 
Fax Number: 

Payment Information Below:
Card Type: 
Card Number: 
Expiration Date: Month:

Year:

 

Three Digit CSC Code: (on back of Credit Card):
Name On Card:


Fax Signed Form To: 1-847-718-1011. All gift items will be shipped to the address specified on the point redemption order form. We can not ship to a P.O. Box! By signing this application you give the authorization to charge your credit card for prize gift items ordered from our catalog within your specified credit limit.

 

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Authorized Signature (Sign on the line above)