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I would like __________ (quantity) $25 gift certificates Total $___________.00 |
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I would like __________ (quantity) $50 gift certificates Total $___________.00 |
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I will pick-up my order on ________/________/________ or |
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Please mail my order to (one mailing address per form) |
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NAME _______________________________________________________________ |
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ADDRESS ____________________________________________________________ |
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CITY ________________________________ STATE ________ ZIP ______________ |
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I hereby authorize Bodee’s Restaurant to charge my credit card
$___________.00 on the following date ________/________/________. |
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CREDIT CARD TYPE ________ MC ________ VISA ________ AX |
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NAME ON CARD ________________________________________________________ |
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ACCOUNT NUMBER ______________________________________________________ |
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EXPIRATION DATE ________/________/________ |
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BILLING ADDRESS ______________________________________________________ |
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CITY ________________________________ STATE ________ ZIP ______________ |
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PHONE NUMBER _______________________________________________________ |
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CARDHOLDER’S SIGNATURE _______________________________________________ |