Hotel Levesque
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Gift certificates
Special deals

Gift-certificates Request

To order one or more gift-certificates from Hôtel Levesque, fill out and submit this protected and encrypted form. Or call us at 418 862-6927 or toll-free at 1 800 463-1236. Our staff will be happy to help you in any way.

Fields in bold are required.


Billed to


  Mr Ms

First name

Last name

E-mail
·name@domain.com


Company: 

Function: 

Address

City

Country

Province/State
If other:

Postal Code
·X9X 9X9


Phone
·(555) 555-5555


Fax: 
·(555) 555-5555



Delivered to


Deliver at the same address Yes No

Mr Ms

First name

Last name

Address

City

Country

Province/State
If other:

Postal Code
·X9X 9X9


Phone
·(555) 555-5555



Information on the gift-certificate(s)


Number of gifts
If other:

Purpose of the
gift certificate(s)

If other:

Value per gift
If other:

Payment method


Credit card information


A credit card is required to confirm and guarantee your gift-certificate(s). Because we take your security seriously, we use a secure website to process your transaction and ensure the confidentiality of your personal information.


Credit card

Credit card number

Expiry date:  YYYY   MM 

Cardholder name


Other information


How did you discover our website?
If other:

Comments or questions: 
·Max 500 characters


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  Reservation : 1 800 463-1236     Last update: Thursday, May 17, 2012     © 2006 - 2012 - Hôtel Levesque