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Gift Certificate Form
Gift From
All Fields are mandatory
Name of Person Paying for Gift:
Street Address:
City:
State:
Zip:
Telephone No:
Mobile No:
Email:
Gift For
Full Name of Person Receiving the Gift
Type of Gifts:
Entire Stay
One Night Stay
Dollar Amount:
$50
$100
$200
Bottle of Wine (Red or White): $35
Flower Value up to $50 Maximum
Dinner for Two $50 (Available during Summer months only)
Breakfast for Two $20 (Available during Summer months only)
Credit Card Details
Credit Card Holder Name:
Credit Card No:
Credit Card Expery Date:
Comment from Payer:
Authority Letter:
I authorized Hillside Lodge to charge my credit card for the gift I selected for person whose name appears on this certificate. I understand that this Gift is non-cancelable and no credit will be issue once processed. This certificate is valid for one year from the date of request. By marking I AGREE, I understand that it is my electronic signature, "Submit" to authorize.
I Agree
Signature:
Special Promotions
Go to "Reservation" Panel above &
Enter Dates and Click on "GO"
Discount offer...
Now offering Last Minute Deal
We offer Travel agent discount
Call for a Group Rates
Area Attractions
The area around Hillside Lodge is full of things
to do, places to go and things to see...
Resort Gift Certificate
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© copyright 2010 - Hillside Lodge
Hillside Lodge, 125 Hillside Lodge Drive, Route 390
Canadensis, PA 18325
Tel: 1-570-856-1433
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