Non-profit Order Form

This printable form is provided for offline orders sent by regular postal mail. Upon receipt of your order and payment,
we will send your Gif Certificate orders.

Name of Club:	______________________________________________________________
Camp to Support	Camp Casey Kiwanis Camp Mt Hood Kiwanis Camp Other _________________
Contact Person :	______________________________________________________________
Address:	______________________________________________________________
City:	_________________________	State/Province:	_______ Zip Code:_________
Email Address:	_________________________	Phone Number:	______________________________

100% MONEY BACK GUARANTEE FOR ALL GIFT CARDS RETURNED WITHIN 30 DAYS OF PURCHASE....
QTY	Title	Price USD	Amount Due
	30 Gift Card Pkg. @ $10.00	$240.00
	30 Gift Card Pkg. @ $25.00	$600.00
	30 Gift Card Pkg. @ $50.00	$1,200.00
	10ea. Gift Cards - $10, $25, $50	$680.00
	Get 25 $25 Theme Gift Cards and 25 Theme Collection Catalogs in this convenient bundle.	$530.00
	Get six $25 Theme Gift Cards and six Theme Collection Catalogs in this convenient bundle.	$125.00
	30 $25 Gift Cards and 30 Theme Catalogs	$615.00
Super Charge Your Order With Family Avenue Catalog:
	Theme Catalog min. 30	$15.00
	Gift Card Instruction Insert 25 pkg.	$7.50



	Subtotal
	Add $8.50 Shipping
		Total Amount

Payment Method

___ Check or Money Order

Payable to: American Community Service, LLC

U.S. Dollars Only

____ Credit Card

___ Mastercard ____ Visa ____ American Express ____ Discover

Card # ________________________________________ Expiration Date: __ __ /__ __ (MM/YY)

Cardholder's Name:______________________________ Zipcode:______________

Please mail this form along with payment to:
( US Dollars only )

American Community Service, LLC
P.M. Box 255, 1785 Ocean Blvd. NW
Coos Bay, OR 97420

Thank you for your Order!