Gift Certificate
Order Form
To order today
simply print this page, complete this form and either fax it
to (202) 244 6603,
mailGift Certificate Order Form to,
Indique Restaurant 3512-14 Connecticut Ave. Washington DC 20008
Attn: Manager(no cash, please)
or call: (202) 244 6600
|
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 |
|
|
|
$________ |
| color="#ff6600"Card
and Card number ________________________________ |
Exp.
Date
|
_________
|
| Cardmember's
Signature |
_________________________________________________ |
Allow 1 week for
standard mail delivery