PIPER GIFT CARDS

Amount of Gift Card (Any amount: $50, $105, $14.87, etc.)  

If we are sending to the receiver, would you like us to add a special note? (optional)

"Happy Anniversary!", "Have a great night out - we'll watch the kids!", "Thanks for Everything", "Happy Valentine's Day!"

CREDIT CARD INFORMATION

Credit Card   ___Visa ___MasterCard ___Discover ___American Express

Credit Card # Expiration Date

Send Receipt to (optional)

Name

Business (if applicable)

Address

City

State Zip

Work Phone(optional)   Home or Cell Phone (optional)

Fax Number (optional)

E-Mail (optional)

MAILING INSTRUCTIONS  - Mail Gift Card(s) to:

Name

Business (if applicable)

Address

City

State Zip

On Gift Card Envelope, To:____________________________________________________

From: ______________________________________________________________________

Or Gift Card Folder (only with each individual $100 gift order)

Occasion ___________________________________

Feel free to print order form and either

Fax to: 616-335-6797 (Attention: Melodie)  or

Mail to: Piper Restaurant, 2225 South Shore Dr., Macatawa, MI 49434 or

E-Mail: All relevant information to: Melodie@PiperRestaurant.com

Thank you.