Salut! Wine Co. - Gift Certificate Order Form

Gift Certificate Order Form

Certificate Information
Name(s) to appear on certificate:
Amount of Certificate		$.

Billing Information
Bill To:
Card Number		*(We will call you for this information)*
Expiration Date
Name on Credit Card

Contact Information
Your Name
Your E-mail
Your Daytime Telephone

Shipping Information
Send To Name:
Arrive By Date		Hold certificate at Salut! for pick-up Send certificate immediately Send the certificate to arrive on or before:
		(we will include a gift card in the envelope if desired. Please list what you would like the gift card to read in the "Additional Comments" below.)

Send To Address:
Address 2 (Apt./Suite)
City
State
Zip

Additional Comments