Gift Certificates at Restaurant Nora

Enter in Payee Information:

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Bill to:

Name *

Street *

City/St *

Zip Code *

Day Phone * Ext.

E-mail Address *

Card Number *
(no spaces)

Expiration Date (MM/YY)*

Gift Certificate Amount*

Enter in Recipient Information:

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Address Gift Certificate to:

Recipient *

Street Address *

City/St *

Zip *

Day Phone *

E-mail Address *

Send to *: Buyer
Recipient

Saying on Card (please keep to 20 words):