ASSATEAGUE EXPLORER

ORDER FORM - GIFT CERTIFICATE

NAME: (First)____________________ (Last)_______________________ DATE: ________________

MAILING ADDRESS:________________________________________________________________

__________________________________________________________________________________

E MAIL ADDRESS: ________________________________ HOME PHONE: ___________________

ORDER the following (Print another order form for each additional certificate.) :

The amount $_______________

Please send the gift certificate(s) to:

NAME ___________________________________

ADDRESS ________________________________________________________________________

_________________________________________________________________________________

I am sending the payment of $_______________ by Cashier's Check or Money Order for the gift certificate.

COMMENTS:

* Please allow 7 days to receive the certificate.