Gift Card Order Form
COMPLETE AND FAX TO: 301-474-3423
OR MAIL TO
SIR WALTER RALEIGH INN
6323 Greenbelt Road
College Park, MD 20740
Please Print
Date: __________________
Mail Gift Card to: Purchaser Recipient
Purchaser’s Info:
Name: _________________________________________
Address: _________________________________________
City/St/Zip: _________________________________________
Phone: _________________________________________
E-Mail: _________________________________________
Credit Card #: _________________________________________
(Visa, Mastercard and American Express accepted.)
Exp. Date: _________________________________________
Gift Card
Recipient’s Info:
Name: _________________________________________
Address: _________________________________________
City/St/Zip: _________________________________________
Birthday: $__________________
Anniversary: $__________________
Gift Card Amount: $__________________
I authorize Sir Walter Raleigh Inn to charge my credit card in the amount requested above.
Purchaser/Card Holder’s Signature: ________________________________________
Official Use Only:
Gift Card # 000000 0000000 __ __ __ __ __ __