Gift Certificate Request Form
Name : _________________ Phone # (      ) ______ - ________
Who should we mail the gift certificate to?		[  ] Purchaser	[  ] Recipient
Address: 	_____________________________________________
_____________________________________________
_____________________________________________
Please print:
TO: Recipient Name(s)  ___________________________________
___________________________________
FROM :	           	___________________________________
___________________________________
[   ] Leave purchaser name Blank   [    ] Leave recipient name blank  [  ] Leave both names blank
Package : Please select a package for the recipient (price chart listed on the bottom):
Lake Merritt Packages:
[  ] Marco Polo	[  ] Casanova	[  ] La Cortigiana	    [  ] Promessi Sposi
Number of Passengers : ____________  ****Gondola holds up to 6 people****
Total = 	$__________________
Please print this form, completely fill it out and mail with check or money order payable to: Gondola Servizio.
Or, Fax this form to : Gondola Servizio (510 ) 238-7199  along with your phone # and we will call you for your credit card # and to verify we received your request. If we do not call you, please call us, there may be a problem with the fax transmittal.
Gondola Servizio - (510) 663-6603
568 Bellevue Avenue
Oakland, CA 94610
Price Chart
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# of  people   	2	3	4	5	6
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Marco Polo	$45	$55	$65	$75	$85
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Casanova	$75	$85	$95	$105	$115
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La Cortigiana	$100	N/A	N/A	N/A	N/A
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Promessi Sposi	$225	N/A	N/A	N/A	N/A