Chapter Eleven

To order, complete form below and press "Submit" button or call your order in (509) 467-7011. Please allow up to 24 hours for processing the gift certificate.


	Name:
	Address:
	City:
	State:
	Zip Code:
	Phone #:
	Amount of Gift:
	Payment Method:	Credit Card (via Internet) Print Screen/Fax Print Screen/Mail
	Credit Card Type:	Visa Master Card Discover American Express
	Credit Card #:
	Exp. Date:
	What should we do with your gift certificate?
	Mail certificate to above address Hold certificate at Chapter Eleven's main office (Valley) Mail certificate to the following address (if different from above)
	Name:
	Address:
	City:
	State:
	Zip Code:
	Please make Gift Certificate out to/from:
	To:
	From:

	Note: If you prefer not to submit your credit card information over the Internet or prefer to pay by check, you may fill in appropriate information on this form, PRINT FORM and MAIL or FAX it to:
	Mail:	Chapter Eleven E. 105 Mission Spokane, WA. 99218
	Fax:	(509) 326-9480

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Š1997,1998 Chapter Eleven Restaurant