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         PRODUCT GIFT CERTIFICATE ORDER FORM

                    To order your gift certificate, please enter the information below.

Recipient Name	_____________________________________
Certificate Amount	_____________________________________

                                                     --- Please circle your choice of payment ---

                                                        

                                             

For your convenience, you can make payment to keithloehrer@bigfork.net using PayPal.

Card#  ____  ____  ____  ____      ____  ____  ____  ____      ____  ____  ____  ____      ____  ____  ____  ____ 

Expiration Date ______ / ______ /__________  Signature X_________________________________________

On the back side of your card, give us the last 3 digits next to your signature.   ___  ___  ___ 

Name: ___________________________________________________________ Date : ____ /____ /__________

Address: __________________________________________________________________________________

City: ____________________________________________________ State: ______ Zip: __________________

Home# ( _______ ) ________ - _____________                           Cell# ( ________ ) ________ - _____________

Mail Today To:  Keith Loehrer   P.O. Box 334  Bigfork, MN  56628