To order by fax or mail, print out the form below. If you are paying by check
or money order, include it with the form and mail both to:
Shootz Cafe
I.C.O. Mallorca Restaurant
2228 E. Carson Street
Pittsburgh, PA 15203
You may also order by phone at 412-488-1818. You can mail this form to
the above address with your check or money order. If you want to order our
gift certificate by fax, complete the form and fax it to 412-488-1320.
Be sure to include your credit card information. You may also stop by the
restaurant and purchase gift certificates in person!
Order Form
Please fill in the amount of the gift certificate you would like to
purchase.
Total: $________
First name:
______________________________
Last name:
_______________________________
Email:
___________________________________
Phone:
___________________________________
Fax:
_____________________________________
Address:
_________________________________
City:
____________________________________
State: ___________ Zip:
________________
Card type: _______________________________
(Visa,
Master Card, Discover, AMEX, Diners Club)
Card number:
_____________________________
Card expiration date: ____________________
Card security code: ______________________
(optional, located on
back of card)
Ship to: _________________________________
SHIPPING ADDRESS (if different than billing address, above)
Address: _________________________________
City:
____________________________________
State: ___________ Zip:
________________