THE RITZ RESTAURANT
GIFT CARD SALE - BY FAX
PHONE: (949) 720-1800 FAX: (949) 720-1886

I hereby authorize the Ritz Restaurant in Newport Beach, California to charge my credit card for the purchase of gift
cards, to be redeemed at a future date at the restaurant.

The following information has been provided by me for this purpose. My signature confirms this request concerning the
validity of these charges.

GIFT CARD PURCHASE

___________________ Gift Certificate(s) for $_____________________ Each = ______________________ Total

METHOD OF PAYMENT

Credit Card Type : MC VISA AMEX* DINERS DISCOVER (Circle One)

Account # ___________________________ Expiration Date ______________

* If using an American Express Card, please write the four digit number
printed on the face of the card: __________

RETURN THIS FORM WITH A PHOTO COPY (FRONT & BACK) OF YOUR CREDIT CARD

Cardholder Name
Cardholder Address
 
Business Phone
Home Phone
Signature of Cardholder
Gift Certificate to be sent to:
Address
 
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