Madidi Gift certificates make ideal gifts. They can be used year-round, and you can give them for every occasion!

PO Box 69
Clarksdale, MS 38614
(662) 627-7770

Apply by mail/fax:

• Click on your internet browser to print this form.
• To apply by fax, send the completed form to (662) 627-3400.
  Be sure to include all necessary credit card information.
• To apply by mail, send that completed form with your payment (check, money order, credit card).
• To order through email, or for any additional questions, please contact madidi@bellsouth.net
  

Your Name (please print clearly):________________________________________

Company (if applicable):________________________________________________

Address:_______________________________________________________________

City:___________________________________ State:_________ Zip:____________

Daytime Phone (Please include Area Code):______________________________

Check (Please check if check is enclosed):________________________________

Charge to (Please check): VISA______ MC______ AMEX_____ DISCOVER______

Account No.:_____________________________________ Expir. Date____________

Signature:______________________________________________________________