Title: François Lecoin
Author: ray

Form for purchasing with CC information:  Gift Certificates, Massages

Your Gift Certificates information   and/or   Credit Card information

Gift Certificate will be sent on JPG (picture) format unless otherwise mentioned.

Your purchase:

Number of Certificates:                  @  $               /ea
or
Number of Massages:                   @  $               /ea

* Your First and Last Name:     
* Your email address:                
* Your Cell number (or home phone #):           
* Amount to Charge on CC:                              
* CC name: Visa, MC, Am-Ex., Discov.:        
* CC number:                                        
* CC expiration date (mm/YYY):         
* CC code:                         
* CC billing zip code:        
* CC name on card:           
(*) must fill up
~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~  ~

If applicable:

Offered or Presented by          , if other: ….. 
For:    (receiver’s name if applicable): ……..
Note i.e. Happy Birthday, etc.:…..

Receiver’s information:
Receiver first and last name (if applicable): …..
Receiver Cell number (if applicable): …..
Receiver email address (if applicable): …..

Please fill up this form and attach to email send to Francois Lecoin at Flecoin1@gmail.com
Thank you,    

Cell: 678-697-1605     www.BodyWS.com

François