Thomas & Carman Convenience Stores

Your name

Your phone number

Your Address

Your City, State, Zip

Name of recipient

Phone number of recipient:

*Address you want the gift basket delivered to

Your E-mail:

E-mail of person you are sending gift to:

Student's Year in School
Freshman Sophomore
Junior Senior
Grad Student

Date you want basket delivered

Please fill out this section for the gift card information.
The gift card will be sent to the delivery address you have indicated (*).

Please type any special message you wish to be included on the gift card:

2. Sign and date the form.

Signed__________________________________Dated__________________________________

3. Print form.

4. Enclose your personal check or money order and order form in an envelope, and mail it to:

Eastern Illinois University
600 Lincoln Ave.,
MLK Jr., University Union
Attn: Panther Dining
Charleston, IL 61920

Thank you for purchasing a gift basket.
If you have any questions, please feel free to contact us at 217/581-3700.

Brian Schneider Carman Assistant Director of Panther Dining

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