  	   Bistro Français 
     R E S T A U R A N T
     Gift Certificate Order Form 
      
     To order today simply print this page, complete this form and either fax it      to Fax: 202.338.1421
     mail Gift Certificate Order Form to,
       Bistro Français 3124-38 M Street  Washington, D.C.  (no cash, please) 
     or :Call: 202.338.3830

Provider

Credit card number Exp.

Full name as it appears on card Last name

Address and phone number

Provider's signature

Amount $

Number of certificates Subtotal $

Overnight service fee $ 16.00

TOTAL CHARGED TO CARD $

Gift certificate recipient

Provider American Express Visa Master Diner Club Credit card number Exp.

Full name as it appears on card Mr Mrs Miss Last name Address and phone number

Provider's signature

Amount $

Number of certificates Subtotal $

Overnight service fee $ 16.00

TOTAL CHARGED TO CARD $

Gift certificate recipient

Provider

Credit card number Exp.

Full name as it appears on card Last name

Address and phone number