Gift Certificate Information:

To: ______________________________________________
From: ____________________________________________

Gift Amount: $________________________

Would you like a receipt mailed to you? Please include your email or address below:

Name: _____________________________________

Address: ___________________________________

Address 2: ______________________

City: __________________________

State: __________________

Zipcode: _______________

I authorize Rossini’s Restaurant to charge the above listed amount to the credit card listed below. Furthermore, I authorize the delivery of the above listed gift certificate to the address specified.

Signature: _______________________________

Date: ________/________/_________

Mail Gift Certificate to:

Name: _____________________________________

Address: ___________________________________

Address 2: ______________________

City: __________________________

State: __________________

Zipcode: _______________

Billing Information:

Cardholder Name: _________________________________________

Billing Address: _____________________________________

Billing Address 2: ___________________________

City: _____________________

State: ________________

Zipcode: _____________

Card Number: _______________________________________

CVV: ___________ Exp Date: ______/______