Bloomingdale's The Shopping Benefit

Please print this page, fill in and FAX or mail to the address below:

Please charge my credit card in the amount of $10.00.

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Card Number _________________________________     Exp. Date  _____ / _____

Signature ____________________________________

Name _______________________________________

Address _____________________________________

City _________________________________ State __________ Zip ________________

Daytime telephone number ______________________

 

The Gabe W. Miller Memorial Foundationsm
1954 First Street, Suite 245
Highland Park, IL 60035
Phone: (847) 721-5050
Fax:     (847) 607-8249