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Spruill Center for the Arts
Gift Certificate

Good for one year from the date payment is received.

Date:

Print this form after completing.  FAX 770-394-6179.
After payment is received, a gift certificate will be sent to the following:

Gift Certificate Recipient Information

Gift Recipient Name:
Gift Recipient Address
CityState Zip
Day PhoneEvening Phone
Name of Gift Giver to appear on the Gift Certificate:

After payment is received and the registration is processed, a gift certificate will be (choose one):
Mailed to gift recipient     Mailed to payor/ gift giver      Picked up at The Spruill Education Center

Payor/ Gift Giver Information

First NameLast Name

Address
CityState Zip
Day PhoneEvening Phone
e-mail

CHECK #
CREDIT CARD
CARD NUMBER   -     -   - 
EXP DATE -   CVV#   3-DIGIT NUMBER ON BACK OF CARD USED TO VERIFY

Name as it appears on card

TOTAL $

Signature __________________________________________  
A signature is required for all credit card transactions.  Unsigned forms will not be processed

Print and SIGN completed form then fax: 770-394-6179 or mail: 5339 Chamblee Dunwoody Rd. Atlanta, GA  30338
Credit card registrations must be signed to be processed.