Shopping Spree
www.localshoppingspree.com
Spree Card Order Form
All fields are required unless they are marked optional.
Your local Shopping Spree Card is just $65.00 per card!
Select
Choose Your City
Iowa - Cedar Rapids
Iowa - Davenport
Iowa - Dubuque
Iowa - Iowa City
Iowa - Mason City
Iowa - Sioux City
Iowa - Waterloo
Minnesota - Albert Lea/Austin
Minnesota - Duluth/Superior
Minnesota - Mankato
Minnesota - Rochester
Minnesota - St. Cloud
North Dakota - Bismarck
North Dakota - Fargo
Wisconsin - Appleton
Wisconsin - Eau Claire
Wisconsin - Green Bay
Wisconsin - La Crosse
Wisconsin - Superior/Duluth
Quantity
1
2
3
Promotional Code
(Please use the promotional code you were given over the phone.)
BILLING INFORMATION
Email
(optional)
First Name
M.I.
Last Name
Address
Apt./Lot No.
(optional)
City
State
Zip Code
Phone No. w/Area Code
Check here if your billing address is the same as shipping
SHIPPING INFORMATION
(optional if your billing address is the same as your shipping address)
First Name
M.I.
Last Name
Address
Apt./Lot No.
(optional)
City
State
Zip Code
Phone No. w/Area Code
ADDITIONAL INFORMATION
CREDIT CARD INFORMATION
Card Holder's First Name
Card Holder's M.I.
Card Holder's Last Name
Card Type
Discover
Mastercard
Visa
American Express
Expiration Date
01
02
03
04
05
06
07
08
09
10
11
12
2007
2008
2009
2010
2011
2012
2013
Credit Card number
CVV2 Code
(3-Digit number in signature panel of card)