Rossini's Gift Certificate

Please fill out this page and print using the Print button at the bottom of the form.
You can then fax it to 212-686-0987.

Gift certificate to read as follows:

To:      

From:

Gift Amount: $

Mail Gift Certificate to:

Name:    

Address 1:

Address 2:

City: State:
Zipcode:

 

Would you like a receipt mailed to you? Yes No

Billing Information:

Cardholder Name:

Billing Address 1:         

Billing Address 2:         

Telephone: (home)    (work)

Card Number:       Security Number:      Exp. Date:

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.

Signed:_________________________________________ Date: ______________

Additional Instructions / Requests:



Please fax to: 212-686-0987.