Please print this page, complete the form and fax or mail as shown below.
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| Purchaser Name | _____________________________________________ |
| Address | _____________________________________________ |
| City | _______________________ |
| State | _______________________ |
| Zip | ______________ |
| Telephone | ______________ |
| _____________________________________________ | |
| Please indicate either the services you would like to purchase with this gift card or the dollar amount of the gift card |
Services:___________________________________ ___________________________________ ___________________________________ __________________$_________________ |
| Please enter the recipient's name, full mailing address and phone number |
Name_____________________________________________ Street_____________________________________________ City_____________________State_______Zip____________ |
| Please indicate where the gift card should be mailed |
___ Please mail the certificate to me as the purchaser. ___ Please mail the certificate to the recipient. |
| Payment Method |
___ Check (certificate will be mailed on receipt of check) ___
Credit Card Credit Card Number __________________________ Expiration Date __________ Signature as it appears on the card __________________________________________ |
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The Spa at Colfax thanks you for your interest in our services and we are confident that your loved one will enjoy this special and thoughtful gift. Please fax your completed gift card form to (574) 288-5760. We will contact you to arrange payment, if necessary. If you prefer, you may mail the completed form to The Spa at Colfax, 224 West Colfax, South Bend, Indiana 46601 Cancellations: Credit card and/or gift card required to secure all appointments. Services cancelled with less than 24 hour notice will be charged 100% of total services. |
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