Address: ________________________________________________________________________


Phone:_______________________________ Email: ___________________________________

To purchase:

• Print this page

• Complete form

• Make check to: “Lakeside Dance Club”

• Mail form & check to:

Email the Dance Club

Dance Club Gift Certificate Order Form

Number of Certificates _____ $ amount of Certificate ______                    Date ____________

Mail Certificates to:

Office Use

Dance Date Purchased: ____________   Date Mailed: ___________  Date Redeemed:____________ Cert # _________

Gift Certificates make a great gift for Holidays, Birthdays, Anniversaries and special thank-yous.  Gift Certificates are also available for purchase during scheduled dances.

Street                                                                           City                                                       State/Zip

Lakeside Dance Club

Arlene Cochran

4th Street NW

Glenwood, MN 56334