INSTRUCTIONS ON FILLING OUT THIS FORM:
You can print out this form, complete it, and mail it in to us. Remember to add a $6.95 to your total or You can take Advantage of our FREE Shipping Offer if you purchase $75.00 or more (before any applicable taxes). Once you have completed and printed this form, mail it to us at the address displayed at the bottom of this page or fax it to (281) 884-6038.

Your Address - Please Print

Name__________________________ Address_____________________________________________________
City / State (Province) ______________________________ Zip Code______________ Country_____________________
Daytime Phone#_______________________ E-mail_______________________________

Shipping Address - If Different From Above

Name__________________________ Address_____________________________________________________
City / State (Province) ______________________________ Zip Code______________ Country_____________________
Daytime Phone#_______________________ E-mail_______________________________

Credit/Debit Card Type (Visa/MasterCard) __________________________
Account Number __________________________________________________
Exp. Date _______________________ CVV Code (3-Digit Code) _________________
Signature ______________________________________ Date ___________________

Code #	Product	Quantity	Price Ea.	Total
			Sub-Total __________
Redeem Coupon Code _____________			Less Coupon ________
Texas Residents Only - Please add 8.25% sales tax			8.25% TX Tax _______
Important			Shipping + ________
Remember to a Add $6.95 Shipping Charge. You can take advantage of Our FREE Shipping Offer with your order of $75.00 or more!
			Order Total ________

Thank You for shopping at drhFineGifts.com!

We appreciate your business!

Please mail your order and make your payment payable to:

DRH Fine Gifts
2107 Quail Valley East Dr.
Missouri City, TX 77459-3323