Gift Headquarters
Catalog Prize FAX Order Form
Print this order form first!  Then fill out the information below.
  Fax the completed signed order form to:  1-847-718-1011
The order will be processed and confirmation will be e-mailed to you.

Location Information:

 Operator Authorization:_____________________________________
Location Name:
 
Location Number:
 
Player Information :
First Name:
 
Last Name:
 
Address:
 
City, State, Zip Code:
 
Daytime Phone Number:
 
E-Mail Address:
 
Prize Information 1:                                     
Item Number:
 
Item Description:
 
Color, Size, Personalization:
 
Quantity: ___________ Points Required:_________________________
Prize Information 2:                                  
Item Number:
 
Item Description:
 
Color, Size, Personalization:
 
Quantity: ___________ Points Required:_________________________
Prize Information 3:                                   
Item Number:
 
Item Description:
 
Color, Size, Personalization:
 
Quantity: ____________ Points Required:_________________________

Point Verification:

    
Attendant name/Auth. code: ______________________Account #:___________
Fax Signed Form to: 1-847-718-1011

All gift items will be shipped to the address specified on the point redemption order form unless otherwise specified.  We can not ship to a P.O. Box.

By signing this order form  you give  the authorization to deliver the prize gift items ordered from our catalog. 

_______________________________________________
Operator Signature

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