| Product ID | Title | Unit Price | Quantity | Price |
| 1000-GIFTCODE | $1,000 Digital Wish Gift Card (Needs 10) | $1000.00 | _____ | $_________ |
| 500-GIFTCODE | $500 Digital Wish Gift Card (Needs 10) | $500.00 | _____ | $_________ |
| 300-GIFTCODE | $300 Digital Wish Gift Card (Needs 10) | $300.00 | _____ | $_________ |
| 200-GIFTCODE | $200 Digital Wish Gift Card (Needs 10) | $200.00 | _____ | $_________ |
| 150-GIFTCODE | $150 Digital Wish Gift Card (Needs 10) | $150.00 | _____ | $_________ |
| 100-GIFTCODE | $100 Digital Wish Gift Card (Needs 10) | $100.00 | _____ | $_________ |
| 75-GIFTCODE | $75 Digital Wish Gift Card (Needs 10) | $75.00 | _____ | $_________ |
| 50-GIFTCODE | $50 Digital Wish Gift Card (Needs 10) | $50.00 | _____ | $_________ |
| 25-GIFTCODE | $25 Digital Wish Gift Card (Needs 10) | $25.00 | _____ | $_________ |
| 10-GIFTCODE | $10 Digital Wish Gift Card (Needs 10) | $10.00 | _____ | $_________ |
| Cash Donation (Any Amount) | ||||
| Shipping (8%): | $_________ | |||
| Tax (5%, Vermont Only): | $_________ | |||
| Total: | $_________ | |||
Credit Card (circle one) Visa Mastercard Amex Discover
Credit Card #: ____________________________________
Expiration Date:____/_____ CVV2* Code:______________
Exact Name on Card: ______________________________
Phone: ______________________________
E-mail Address: ______________________________
Credit Card Billing Address:
______________________________________________
______________________________________________
______________________________________________
Please make all checks payable to "Digital Wish". Please return payment along with this form to the appropriate teacher. Or mail with payment to:
Digital Wish
PO Box 255
Milton, DE 19968
For more information on these products, or to purchase online, visit http://www.digitalwish.org, or call (866) 344-7758.