Tosco's Pizza & Restaurant Gift Card - Formstack

Gift Card Details:
-- One purchase per gift card recipient
-- There is a $3.50 shipping and handling fee with each purchase
-- This is a Secure Credit Card Form

FROM: (YOUR NAME)*

Please Enter Your Email Address*

You will receive an email confirmation when the purchase goes through successfully

Credit Card*

Address Listed on Credit Card*

Address Line 1

Address Line 2

City

State

ZIP Code

Gift Card Value*

Quantity

Total Cost: (+ $3.50 Shipping Cost) $

Shipping Address (This is the address we are shipping gift card to)*

Address Line 1

Address Line 2

City

State

ZIP Code

Name: (NAME) - Who is this gift card for?*

First Name

Last Name

Message (optional)

Would you like to leave a note to be written on your gift card?

Notes (optional)

Do you have special instructions for Tosco's Pizza and Restaurant regarding this Gift Card purchase?
Example: I purchased (2) $100 Gift cards for my Aunt Emma. Can you please send her (1) $200 Gift card? :)