Jimmy K Polkas      GIFT CERTIFICATE Order Form  
NOTE - IF YOU HAVE ANY PROBLEM ORDERING, PLEASE CALL US (440) 846-0404 / 1-866-454-6695
or e-mail customerservice@jimmykpolkas.com

Click "Submit" below to send your order.  No credit card information is needed.
We will email payment options (Invoice, Pay Pal, Credit Card by Phone)
You must fill in the information below completely.

HOW DO YOU WANT THE CERTIFICATE DELIVERED?:  


       Your First & Last Name         Your Street Address: 
                 Your City:  State:     Zip Code: 

        Area Code     Telephone No.     E-Mail Address

    DOLLAR VALUE OF GIFT CERTIFICATE $

         ENTER NAME OF RECIPIENT HERE:
IF YOU WANT IT MAILED DIRECTLY TO THE RECIPIENT, ENTER THEIR ADDRESS ALSO
 

                                                                       You must click SUBMIT to send your order!        
                                                     Be patient - it may take a moment or two to process.........

Reset will CLEAR your information - Click this only if you want to completely start over!
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