GIFT CERTIFICATE INFO SHEET

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Restaurant & Wine Bar
8164 W. 3rd St., LA, CA 90048
Phone: 323.951.1210 Fax: 323.951.0487 www.thelittledoor.com

PLEASE FILL OUT ALL INFORMATION AND FAX BACK TO (323) 951-0487

FROM

GIVER'S PHONE NO.,

ADDRESS & EMAIL

TO

THIS GC SHOULD BE: MAILED O PICKED UP O

RECIPIENT'S ADDRESS

AMOUNT

$

CC TYPE (circle one)

AMEX

MASTERCARD

VISA

CC NUMBER

EXPIRATION DATE

NAME ON CARD

NOTES

SIGNATURE

DATE