Gift Certificate
Order Form
To order today
simply print this page, complete this form and either fax it
to
(301) 656 6722, or
mail Gift Certificate Order Form to,
Indique Heights Restaurant
2 Wisconsin Circle , Chevy Chase , MD 20815
Attn: Manager(no cash, please)
or call: (301) 656 4822
|
Cardmember's
Name & credit Card Number |
Please send
to |
|
Company
name |
Company
name |
|
Address |
Shipping
Address |
|
Daytime
telephone |
Daytime
telephone (for overnight shipping) |
| Gift
Certificate from |
Gift
Certificate to with small message |
| Number
of Gift Certificates: |
$50.00_____ |
$100.00_____ |
Total
amount |
$________ |
| Additional
$12.00 fee for: |
Messenger
or overnight service |
|
$________ |
| Total
Charges |
|
|
|
$________ |
| |
Exp.
Date |
_________ |
| Cardmember's
Signature |
_________________________________________________ |
Allow 1 week for
standard mail delivery