Gift Certificate Order Form (*required fields)

This form is NOT a secure form, please complete this form and then pay with the Paypal link on the next page or call with you credit card information.

Who would you like to send the gift certificate to (Recipient)?

*First Name
*Last Name
*Address
*City
*State
*Zip Code
*Phone Number

*Length of Massage: Massage & Energetic Treatments (with the exception of ISIS): 40 Minutes: $50.00 Massage & Energetic Treatments (with the exception of ISIS): 70 Minutes: $80.00 Massage & Energetic Treatments (with the exception of ISIS): 100 Minutes: $120.00 Outcalls: 70 Minutes: $105 Outcalls: 100 Minutes: $150 Corporate Chair Massage: $75/hour ISIS: 90 Minutes: $145.00 Traditional Chinese Medicine: Initial Evaluation and Treatment: $120 Traditional Chinese Medicine: Follow-Up Visits: $80

*Inscription

Your information

*First Name
*Last Name
*Address
*City
*State
*Zip Code
*Phone Number

*Email

*Shipping Options: None Regular Mail: Free Priority Mail: $5.00 Regular FedEx: $25.00 Saturday FedEx: $35.00

Number of Gift Certificates
(see Reduced Rate Packages for volume discounts)

Total Cost: $ (Be sure to wrtie this number down, as you'll need to submit it to PayPal.)

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