SIRI'S
GIFT CERTIFICATE
Please print out and complete the form below,
then fax to :
856.663.6128
Siri's Thai French Cuisine
ATTN: Vallpa Sittikul

*Be sure to include a photocopy of your credit card (back & front) for signature verification; your order will not be processed without it.

THANK YOU FOR YOUR ORDER

Siri's Thai French Cuisine
2115-2119 Rt. 70 West
Cherry Hill, NJ 08002

TEL: (856) 663-6781
FAX: (856) 663-6128
 


Gift Certificate Order Form

(Date) ................................................

I, , authorize Siri's Thai French Cuisine to sell me
 
.......................................................................................
(Purchaser's Name, please print)

gift certificate(s) at US$ per certificate.

(quantity) ......................... (certificate value) .....................   

I authorize Siri's Thai French to charge my
(credit card type; AMEX, VISA etc.)

.......................


Credit Card#  .............................................. 

Expire date:  ................................................
 


I understand that the Gift Certificate will be mailed to the address indicated below.
I understand that Gift Certificates expire one year from date of issue and are non-refundable.

Purchaser's Signature ..........................................
Tel: ....................................................................

Purchaser's Billing Address:
Street ........................................................................................
City ..........................................................................................
State .........................................................................................
ZIP............................................................................................

Mailing Address:
Street ........................................................................................
City ..........................................................................................
State .........................................................................................
ZIP............................................................................................

Special Instructions:    ................................................................

Certificate in the name of:   ..........................................................

Shipping (please select an option)
Regular Mail   ( $5.00 shipping and handling fee will apply)
..........
FedEx  ($20.00 shipping and handling fee will apply)
..........