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Mailing Address:
4167 Albany Post Road, Hyde Park, NY 12538
Fax: (845) 229-9136 Questions or Info Call: (845) 229-9136

I, __________________________________, authorize the Coppola Family to sell me _____ Gift Certificate(s) for $_____________. To be used at either Coppola's of Hyde Park or Cappuccino by Coppola's in Poughkeepsie. If paid by Credit Card, I authorize the Coppola Family to charge my:

Type of Card: ______________________________________________
Credit Card No: ____________________________________________
Expiration Date: ____________________________________________

I understand that the Gift Certificate(s) will be mailed to the address indicated below and that the Gift Certificate(s) expire in one year and are non-refundable.
_________________________________________
Signature

Name: _________________________________________________
Street Address: _________________________________________
Town: _________________________________________________
State: ________________________
Zip Code: _____________________
Telephone: ____________________
Special Instructions: _____________________________________