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Certificate Form

Gift, Donation and Bereavement Certificates

Looking for a unique gift or a way to memorialize the passing of a wonderful canine companion? LABMED offers: Gift Certificates, Bereavement Certificates and Donation Certificates.

Instructions:

Please fill out the following sections completely. We will custom print each certificate using the information you provide. The donor section should contain information about yourself. Please indicate which type of certificate you wish to order by clicking on the appropriate button. In the corresponding certificate order section, please provide information about the individual you wish to give this certificate. Should you have questions regarding formatting or information placement, please click the appropriate certificate image or e-mail hbowden@koyote.com.

Bereavement and Donation Certificates can be issued in any amount (over $1). Gift Certificates are available in denominations of $5, $10, $25, and $50.

Information about the Donor:

Contact Name:
Street Address:
City:
State:
Postal/Zip Code:
Country:
E-mail:

Type of Certificate?
Gift
Bereavement
Donor

Payment Method?
Check
Visa/MasterCard


Donation Certificate Recipient:

Name to Appear on Certificate:
Street Address:
City:
State:
Postal/Zip Code:
Amount:
E-mail:
Donation Made By:

Comments?

The information provided in the Donation Certificate Section will be used to create and send a custom printed certificate to the above named individual(s). A formal Donation Letter will be sent to you utilizing the contact information you provided in the Donator Section. This donation letter will include the donation date, amount donated, and our Federal Tax Number. Please remember that all donations are tax-deductible and are very much appreciated. If you would like to include a personalized phrase, please feel free to do so in the Comments box in the section above.

Gift Certificate Recipient:

Name on Certificate:
Street Address:
City:
State:
Postal/Zip Code:
Amount:
E-mail:
Donation Made By:

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.

Bereavement Certificate Recipient:

Name to Appear on Certificate:
Street Address:
City:
State:
Postal/Zip Code:
Amount:
E-mail:
Donation in Memory of:
Donation Made in Name of a Pet or Individual?
pet
individual

Comments?

The information provided in the Bereavement Certificate Section will be used to create and send a custom printed certificate to the above named individual(s). A formal Donation Letter will be sent to you utilizing the contact information you provided in the Donator Section. This donation letter will include the donation date, amount donated, and our Federal Tax Number. Please remember that all donations are tax-deductible and are very much appreciated. 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 will allow us to contact you in the event of questions concerning your certificate order.

When your check or money order arrives we will ship your certificate. To pay by credit card, fill out and submit the order form to process your request. Then call 972-208-2470 between the hours of 8AM - 8PM CST to supply your credit card information.

If you wish to pay by check or money order, when your form is complete, please submit it (you may wish to print a copy for your records) and mail a copy, along with your check or money order, payable to LABMED, to:

Deb Hamele, LABMED Treasurer
1813 Axel Avenue
Madison, Wisconsin 53711

Offering one of our custom printed Bereavement Certificates to a grieving friend is an thoughtful way to express your condolences. We'd like to offer a few additional items that you might like to accompany your certificate. Perhaps a custom embroiderable afghan throw would be a fitting memorial tribute or one of several carefully chosen books that deals with this painful subject.

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