School of Continuing Education Gift Certificates Order Form


School of Continuing Education Gift Certificates

Order Options:
	Fill out and submit this form online
	Print and mail order form to:
		Non-credit Registration University of Wisconsin-Milwaukee Drawer No. 491 Milwaukee, WI 53293-0491

	Call Toll-free 800-222-3623 or Direct 414-227-3200
	Print and fax order form to: Toll-free 1-800-399-4896 or Direct 414-227-3146


	For multiple orders, please use multiple forms. Fields marked with * are required.

	Your Name *
	Business Title/Position
	Organization Name
	Address *
	City *
	State or Province *
	ZIP or Postal Code *
	Daytime Phone Number *
	Keycode	(Please transfer the keycode that appears to the left of your name on the catalog mailing panel.)

	Deliver To: (if different from above)
	Name
	Organization Name
	Address
	City
	State
	ZIP Code

	Method of Payment:
	Certificate Amount:	$ ($20 minimum)
	Payment:	Credit Card Type * Credit Card Number * Expiration Date * CCV Number * Cardholder's Name * Address of Credit Card Statement * Zip Code *

	To	(Recipient's name as you wish it to appear on the gift certificate)
	From	(Your name as you wish it to appear on the gift certificate)
	Personalized Message	(20 words maximum)