BAKERS’ ACRES
GIFT CERTIFICATE ORDER FORM

Please Print

Date: ___________________
Purchaser Info:
Name: __________________________________________________________
Address: ________________________________________________________
________________________________________________________________
Telephone No.:____________________________________________________
Amount: ____________________________________________

Check Enclosed: ___________ OR

Credit Card (Please check one):
Visa______ MasterCard ______ Discover ______
Account No.: ___________________________________
Expiration Date: _________________________________

“Courtesy of:”_____________________________________________________

Recipient Info:
Name: __________________________________________________________
Address: _________________________________________________________
________________________________________________________________

Please mail my gift certificate to:
Me: ____________ Recipient: ____________
Optional Message: _________________________________________________
________________________________________________________________
Mail to: Bakers’ Acres, Inc., 1104 Auburn Rd., Groton, NY 13073
Thank You!