Purchase Cards

Fill out and submit this form, you'll receive a confirmation number within 24 hours,
send the confirmation number along with your cash, check or money order to:

Jaime
P.O. Box 752
Cornell, WI 54732

Your Name:

Your E-mail Address:

Your Mailing Address:

City: State: Zip Code:

Write the card names in the spaces below. If more than one, put the number in the box beside the space you put the name of the card in.

Prices of cards are : 1 = $3.95 6 = $21.95 12 = $45.95

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Type of payment: Cash Check Money Order

Grand Total: $