Please fill out this page and print using the Print button at the bottom
of the form.
You can then fax it to 212-686-0987.
Gift Amount: $
Mail Gift Certificate to:
Would you like a receipt mailed to you?
Billing Address 1:
Billing Address 2:
I authorize Rossini's Restaurant to charge the above listed amount to
the credit card listed below.
Furthermore, I authorize the delivery of
the above listed gift certificate to the address specified.
Signed:_________________________________________ Date: ______________
Additional Instructions / Requests: