The White Inn
Gift Certificate Order Form
Don't forget to order your Gift Certificate for the Holidays

Billing Contact
Name:
Address:
City: State:
Zip Code:
Phone:
E-mail:

Payment Information
Credit Card Number:
Expiration Date (mm/yy):

Ship To (if different than billing contact)
Name:
Address:
City: State:
Zip Code:

Order Details
*Certificate Value: (minimum $10)
Special Instructions:


* a $1.00 shipping and processing fee will be added to your total