Rising Sun IN 47040
			Phone: 1-800-GRAND-11
			FAX:1-812-438-5151
		Gift Certificate by Phone
		Purchaser:			Date:
		Name:
		Street:			Mail out
		City:
		State/Zip			Pick up
		Phone#:
		Fax#:
		Receiver:   If a receiver is named, the certificate will be sent to that person.
		Name:
		Street:
		City:
		State/Zip
		Phone#:
		Payment INFO
		Credit Card #
		Expire Date:		Type of Card:
		Date:
		Purchaser Signature:
		Gift Certificate
		Amount:	$
			must be multiple of $ 25.00  ($25.00 and $100.00 available)
		From:
		To:
		Signature will be required for all deliveries.  If you choose to deny the required signature,
		Grand Victoria will not be responsible for any lost or misplaced deliveries.
		Mail-Out:  All certificates will be mailed by Fed Ex.  Please indicate which delivery you choose.
		Paperwork received after 2pm will be mailed on the next business day.
		FedEx Ground:		$5.00
		FedEx Overnight:	next business day	FedEX will charge
		FedEx Overnight:	next day by 10 am	to customer C.C.
		FedEx Saturday:	Saturday delivery
		To be filled out by Gift Shop Employee:
		Received on:	Mailed by:
		Received by:
		Completed on:	Mailed on:
		Completed by:
		Gift Certificate #'s :
		Micros Receipt #: