Gift Card Order Form

Print this form and fax completed form to (562) 598-8554 

When you are finished printing the form, Click on the Logo to return to the home page.      

Please complete order form and fax to Walt's Wharf at (562) 598-8554.

Please feel free to call us if you have any questions. (562) 598-4433

We will e-mail you upon receipt of your fax transmission.  Please enter an e-mail address where you may be reached.

_____________________________

 

Purchased By:

Name:________________________________

Street:________________________________

City:__________________________________

State:_______________     Zip:____________

Phone:________________________________

 

Gift Cards are Available in any Amount.

Amount of Purchase:_____________________

Visa        Amex        Master Card        Diners Club

Credit Card #____________________________

Expiration Date:__________________________

Name on Card:___________________________

I authorize Walt's Wharf to charge my card in the amount of $____________

this__________day of___________,200___.

Signature_______________________________________