Send a Gift ! From your heart and home

Paypal Ordering

Use the form below to place your order for Gift Cards.
Once you have filled out the form, you will be taken to a secure area to place credit card order with PayPal.

Please be sure to enter all of the information on this form so we have your mailing address and the gift card information.
Without your correct email address we can not get back to you so all fields are required.

If you prefer to contact us with information by email, send to: cards@hepcassoc.org
Or Call Us Toll Free: 866-437-4377 or Fax: 908-561-4575

Gift Cards will be sent out when your information and donation is received.

Fill the form below
First Name *
 :
Your E-Mail * :
Tel no. * :
 
Your Mailing Address *
Street :
City :
State :
Zip :
 
Name of Person to receive
Gift Card *		 :
 
Mailing Address of person to receive Gift Card *
Street :
City :
State :
Zip :
 
Type of Gift Card
ie. Birthday, In Memory Of, Anniversary, Promotion, New Baby, etc. 		:
Card Style : Irises    Balloons
Amount of Donation * :
Comments :
 
                   
 
Go to top
 

  Home | What is hepatitis? | Our Mission | Who's Involved | Hepatitis C News | Upcoming Events | Brochures | Gift Cards | Related Links | From the President | To Whom It May Concern | Bulletins | Message Board |
All the Joy | Contact Information
 
  © 2005 Hepatitis C Association Inc, All rights reserved.
 Site by netdogz