DALE CLEANERS (614)451-1422  FAX:(614)451-0247	
		
		GIFT CERTIFICATE REQUEST FORM (2006 Winter)

 Sender
	Name:
		___________________________________________________

	Phone (Day Time):
		___________________________________________________

	E-Mail:
		___________________________________________________

	Address:
		___________________________________________________

		___________________________________________________


 Receiver	Same as Above  (  )

	Name:
		___________________________________________________

	Address:
		___________________________________________________

		___________________________________________________

	Phone (Optional):
			___________________________________________

	E-Mail (Optional):
			___________________________________________

 Best Wishes:
		___________________________________________________

		___________________________________________________

		___________________________________________________

		___________________________________________________

 Amount of Gift Certificates:  $			($5.00 Increment)
				__________ 

 Payment:  Visa (   ),  Master (   ),  Discover (    )

		____________  ____________  ____________  ____________  

		    EXP.
			_________

 * Please, Fax 	to Dale Cleaners (614) 451-0247 

		or E-Mail: GiftCertificate@DaleCleaners.com