Gift Certificate PAYMENT AND INFORMATION FORM

Your Name:

Your Email Address:

Your Phone #:

Who is the Gift Certificate For?

Name #1:

Name #2:

Name #3:

Name #4:

Who is the Gift Certificate From?

Name #1:

Name #2:

Name #3:

Name #4:

Is it for a Special Occasion? Select Birthday Gift Anniversary Gift Wedding Gift Engagement Gift Christmas Gift Retirement Gift Other

If "Other" please describe:

For a Specific Cooking Class, please list Location, Class Name and Date

Any other information we may need?

What would you like to purchase? Select Couples Cooking Class Adult Cooking Class for 1 Adult Cooking Class for 2 Kids Cooking Class Teen Cooking Class A Specific Amount Private Chef at Home Other

If "Other" selected please describe:

PAYMENT INFORMATION

Amount of purchase? Select $197.75 - Couples Cooking Class $112.44 - Adult Cooking Class for 1 $197.95 - 2 Adult Cooking Classes $296.63 - 3 Adult Cooking Classes $395.90 - 4 Adult Cooking Classes $197.95 - Adult Cooking Class for 2 $84.75 - 1 Kids Cooking Class $84.75 - 1 Teen Cooking Class A Specific Amount Private Chef at Home Other

If other please fill in the amount:

Form of Payment ? Select Credit Card Gift Certificate Deal Coupon Interac e-transfer

Name on Credit Card
Address
City
Postal Code
email address
Phone #
Credit Card Type Select American Express MasterCard VISA

**Please Note Debit Cards and Prepaid Credit Cards must be processed
in person**

Credit Card #
Credit Card Expiry (mm/yy)
Security Code (VISA & MC on back; AmEx - 4 digits on front)
Amount to be charged including HST