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Purchase a Gift Certificate

* These fields are required

1 My name is

2 Select a gift certificate value

3 I want to purchase a gift certificate for

Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
How did you hear about us?
Terms and Conditions *	I accept the terms and conditions.Please read the terms and conditions
Email newsletter	Please send me the email newsletter
Name of Gift Certificate Recipient
Phone of Gift Certificate Recipient
Email of Gift Certificate Recipient
Any notes regarding the Gift Certificate Recipient	E.g. if you do not want us to send this Gift Certificate to the Recipient (if you would prefer a Certificate you can give as a present) or if you want your gift to remain Anonymous. Or a message to pass on to the Recipient.

4 Donate

5 Payment

	By submitting payment, you authorise Our Lady of Good Counsel to send instructions to the financial institution that issued your card to take payments from your card account in accordance with the terms of Our Lady of Good Counsel's agreement with you.