Claverack rec "Powered by Excellence"

Gift Certificate Order Form

Bold = Required
Italic = Optional

Purchaser
Your Name:
Street Address:
City:
State:
Zip:
Phone Number:	-
E-mail Address:

Recipient
Account Number:
Name:
Street Address:
City:
State:
Zip:
Phone Number:	-

Customer Information
Once payment is received, the money will be applied to the members account and the certificate will be mailed to:
	Please mail certifiacte to recipient. I wish to remain anonymous. Please return certificate to me.

Comments:

Claverack rec "Powered by Excellence"

Claverack REC - People You Can Count On

Office Hours: Monday Through Friday 7:30 a.m. to 4:00 p.m.
Outage Phone Numbers -- 1-800-356-9799 or 570-268-1370