Gift Card Order Form | Legacy Village

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Select Your Card Amount(s)

Amount of the card must be between $10 and $500. Sales over $150 are prohibited unless billing address matches shipping address.

How many cards will you be ordering?*

Please enter a number from 1 to 5.

Total below includes an activation fee of $3 per card.

Card Value*

Card 2 Value*

Card 3 Value*

Card 4 Value*

Card 5 Value*

Activation Fee

Shipping Options*

Customer Pick-up

Standard Shipping

Enter your email address for receipt*

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Yes

No

Total

Billing & Shipping Information

For orders over $150, the billing and shipping address must match.

Name*

First Last

State*

Address*

Street Address Address Line 2 City ZIP Code

Phone*

Total

Billing Name*

First Last

Billing State*

Billing Address*

Street Address Address Line 2 City ZIP Code

Billing Phone*

Total

Shipping Information

Shipping Name*

First Last

Shipping State*

Shipping Address*

Street Address Address Line 2 City ZIP Code

Total

Card funds do not expire. After valid thru date, contact us for a free replacement Card. Unless prohibited by law, a $3.00 fee will be deducted monthly from Card balance starting 1st day after 1 year of inactivity. Activity means any action resulting in a change in Card balance, other than fee imposition, or adjustment due to error or prior transaction reversal. $5 fee to replace lost, stolen, or damaged Card, except as prohibited by law.

Not redeemable for cash or credit, except as stated in Card Agreement. Additional terms are stated in Card Agreement. Purchase, acceptance or use of Card constitutes acceptance of Care Agreement. For Card Agreement, inquiries, or information: www.getmybalance.com or 800-985-4316. Issued by Sunrise, Banks, N.A.

I have read and agree to the terms and conditions

SUNRISE BANKS does not endorse or guarantee the products, information or recommendations provided in linked sites and SUNRISE BANKS is not liable for any failure of products or services advertised on those sites.

Phone

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