GIFT CERTIFICATE

REQUEST FORM

*Gift Certificates are accepted at all 3 restaurants presented on this website.

Print and complete this form.
It may be mailed or faxed.
Be sure to include check or credit card information.

Mailing Address:
Cappucino by Coppola's
4604 Route 9G
Red Hook, NY 12571

Fax #
(845) 876-0394

I, ________________________, authorize Cappucino's Bistro to sell me ____Gift Certificate(s) for $_______.  
If pay by Credit Card:

I authorize Cappucino's Bistro to charge my:

Type of Card: ____________________________________  
Credit Card # ____________________________________  
Exp. 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: ____________________________________  

Thank You!
The Coppola Families