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D Shop LABMED Gift Certificate Worksheet Instructions: Please fill out the following sections completely. We will custom print each certificate using the information you provide. The Giver Section should contain information about you. In the Recipient Section, please provide information about the individual who is to receive the certificate. Should you have questions regarding formatting or information placement, please see the Gift Certificate image or e-mail Heather Bowden. Gift Certificates can be issued in any amount (over $5). Information about the Giver: Contact Name: Street Address: City: State: Postal/Zip Code: Country: E-mail: Payment Method? I will send a Check to the address provided below; I will send a Money Order to the address provided below; I will provide my Visa/MasterCard information via the secure shopping cart payment form; I will use PayPal via the secure shopping cart payment form. Gift Certificate Recipient: Name (to Appear on Certificate): Street Address: City: State: Postal/Zip Code: Amount: E-mail: Comments? The information provided in the gift certificate section will be used to create and send a custom printed certificate to the above named individual(s). If you would like to include a personalized phrase, please feel free to do so in the Comments box in the section above. To complete your request: Please fill out this form completely, including your e-mail address. The requested information you provided in the donor information section will allow us to contact you in the event of questions concerning your certificate order. After you submit the above information, you will need to provide payment information. Please follow the link at the bottom of the Gift Form Results page to complete the donation process. To provide payment using your credit card, fill out and submit the information via our secure shopping cart to process your donation. Should you prefer to provide payment using PayPal, we have provided a direct link via our secure shopping cart to process your order.. If you wish to pay by check or money order when your form is complete, please mail a copy of the worksheet (you may wish to print a copy for your records as well) and your check or money order, made payable to LABMED, to: LABMED, Inc. 3941 Legacy Drive, Suite 204, #A115 Plano, TX  75023 When your payment is received we will custom print and ship your certificate. If you have any questions, please contact us at 972-208-2470.

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