Gift Certificate Authorization Form
PAYMENT INFORMATION
We accept Visa, Mastercard, American Express, Diners Club and Discover. NO CHECKS ACCEPTED.
Name:
Address 1:
Address 2:
City:

State:
Zip:

Phone:
Email:
Gift Card Amount:
Credit Card Type:
Credit Card Number:
Card Holder's Name: (as it appears on card)
Expiration Date: MM/DD/YYYY
Send gift card to the above address?
(if no please fill in the information below):
 No Yes
Recipient's Name:

Recipient's Address 1:
Recipient's Address 2:
AUTHORIZATION
(REQUIRED - this box must be checked to order a gift card at Tony's)
I authorize Tony's Di Napoli restaurant to charge my credit card for a gift card as specified above.

Special Instructions