Gift Card Print Order Form

Please fill out this form, then print it and attach your check or money order and mail to:

Russ' Restaurants Corporate Office
390 East 8th Street
Holland, MI 49423

Number of gift cards: *

Amount per card: *

Available in any amount up to $100

Total amount: *

Who should we mail gift card(s) to?
Name: *

Address Line #1  *
Address Line #2 
City:                                State:         Zip Code:
*

If we are mailing the cards to someone other than yourself, what message should we include with them?

If this is a credit card transaction, please complete following information:

Cardholder Name:

First:                                 MI:          Last:
*

Billing Address:
Line #1 *

Contact Phone: *

Credit Card Type: *

Visa Master Card