Gift Cards for use at Doc Pierce's Restaurant or Matterhorn Banquet & Catering
GIFT CARD ORDER VIA FAX
Quantity: _________ at $_______ . ___ /each
Quantity: _________ at $_______ . ___ /each
Quantity: _________ at $_______ . ___ /each
TOTAL ORDER:
$ ________ . ____
Please fax to (574) 259-9579
PURCHASER:
Name:_________________________________________________________________________________
Address:________________________________________________________________________________
City:___________________________________________________________________________________
State/Zip:________________________________________________________________________________
Phone # (w/Area Code): (________) __________ - ___________
Fax # (w/Area Code) (________) __________ - ___________
Payment Information:
Type of Payment:_Visa, Mastercard, Discover Card, American Express or Diners/CarteBlanche
Credit Card #:______________________________________Required CVV# (on back of credit card)________
Expiration Date: ____________________
SIGNATURE:__________________________________________________________________
*OPTIONAL: Complete (below) ONLY if you want us to mail gift card
directly to RECIPIENT.
Name:_________________________________________________________________________________
Address:________________________________________________________________________________
City:___________________________________________________________________________________
State/Zip:________________________________________________________________________________
Phone # (w/Area Code): (________) __________ -
___________
Gift Card From: ______________________________