Starview® Mail & Fax Order Form
For Electronic Secure Internet Orders Go To: www.specialstars.net Order your Star Gift™ by Mail or Fax by printing and completing this Order Form. Mail this form to: Starview, P.O. Star Box 342, Catharpin, VA 20143 OR Fax this form to: 1-888-443-4609 (Toll Free Within USA) and 1-703-753-8851 (Worldwide, Toll Charge Will Apply).
1. Star Gift Package Selection: Constellation □ $39.00 Universe □ $69.00 Universe Custom□ $89.00
2. Optional Items: Engraved Acrylic Star □ $20.00 Tri-Star □ $15.00 Star Statue □ $125.00
3. Customer Information (Your Name): _________________________________________
Your Address: _____________________________________________________________
Telephone, Home and Work: ________________________________________________
E-mail: ___________________________________________________________________
4. Ship to: (Recipient’s Name): __________________________________________________
Full Address: ______________________________________________________________
Additional Delivery Information (If Needed) ___________________________________
5. Shipping Method: □ 3-5 Day Priority USA ($5.00) □ Express USA 1-3 days ($20)
□ 1st Class Foreign ($25) □ Global Priority Minimum 6-10 days ($30)
6. Total: Calculate the Total Cost. Place Here $_____________ (all Prices are in US Dollars)
Note: Virginia Residents Must add 5% Sales tax (Multiply by .05)
7. Payment by: □ Check □ Money Order □ Credit Card
8. Credit Card Type: □ Visa □ Mastercard □ Discover □ AMEX
Card Number: _____________________________Expiration Date: ____________ (ex 01/05)
Cardholder Name: _______________________________________________
Cardholder Address: _____________________________________________
Cardholder Signature: (Required) ___________________________________
A. Optional Special Heading at the Top of the Certificate: ___________________________
Example: Star Friend, Star Police Officer, Star Husband, Star Lover, etc.
OR Write Your Own Special Heading:______________________________________
B.Name The Star:_____________________________________________________________
(A Person’s Name, Special Name, Term of Endearment)
C. As Requested By: (Optional) __________________________________________________
(Your Name (s), Organization, Group)
D. Salutation & Occasion: _____________________________________________________
(Example: In Honor of Mother’s Day, In Celebration of Your Birthday, etc.)
E. Special Date: (Optional) __________________ Date Placement: □ In Text □At Bottom
F. Special Message, Words, Expressions, Short Poem: ____________________________ ____________________________________________________________
____________________________________________________________
__________________________________ (If you need more space, use a separate sheet)
G. Is This a Memorial For a Deceased Loved One? □ YES □ NO
NOTE: Checks and Money Orders should be made out to Gift Searchers, Inc. Credit Cards will reflect a
charge by Gift Searchers.com All information provided will be kept confidential. Gift Searchers,
Inc. and Starview do not distribute customer information.