Gift Certificate
Order Form
To order today
simply print this page, complete this form and either fax it
to
(301) 330-5123
mailGift Certificate Order Form to,
Bombay Bistro Restaurant, 98 W. Montgomery, Ave, Rockville, MD 20850
Attn: Manager(no cash, please)
or call: (301) 762-8798
|
Cardmember's
Name
|
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 |
|
|
|
$________ |
| Card
and Card number ________________________________ |
Exp.
Date
|
_________
|
| Cardmember's
Signature |
_________________________________________________ |
Allow 1 week for
standard mail delivery
