|
GIFT
CERTIFICATE
REQUEST
FORM
*Gift Certificates are accepted at each of our restaurants presented on this
website.
Print
and complete this form.
It may be mailed or faxed.
Be sure to include check or credit card information.
Mailing
Address:
by Coppola's
4167 Albany Post Road
Hyde Park, NY 12538
(845) 229-0394
Fax #
(845) 229-9136
I, ________________________,
authorize Cappucino's Bistro to sell me ____Gift Certificate(s) for $_______.
If pay
by Credit Card:
I authorize
Cappucino's Bistro to charge my:
| Type
of Card: |
____________________________________ |
|
| Credit
Card # |
____________________________________ |
|
| Exp.
Date |
____________________________________ |
|
I understand
that the Gift Certificate(s) will be mailed to the address indicated
below and that the Gift Certificate(s) expire in one year and are non-refundable.
| |
|
______________________________________ |
| |
|
Signature
|
| Name: |
____________________________________ |
|
| Street
Address: |
____________________________________ |
|
| Town: |
____________________________________ |
|
| State: |
____________________________________ |
|
| Zip
Code: |
____________________________________ |
|
| Telephone: |
____________________________________ |
|
| Special
Instructions: |
____________________________________ |
|
Thank
You!
The Coppola Families |