Gift Card Order TEST Page

Thank you. Your gift card order has been processed.

Please print this receipt for your records. Final billing will be processed in the timely fashion by the order pick up date unless you choose to pay upon pick up at the restaurant.

If you have not received the confirmation email of your order within a few hours, please contact the restaurant and speak to one of the restaurant managers.

*Required

**Your order is not yet complete. Please review your information before clicking submit.**

Order Request

Location* :Gyoza Bar

Amount x Quantity1* :$x12345678910

Amount x Quantity2 :$x12345678910

Amount x Quantity3 :$x12345678910

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Subtotal :

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Delivery Options

Pick UpCourier(Courier to be arranged by purchaser)Regular Mail

Pick Up Date* :

*Please call the restaurant if you would like to pick it up today.

Mailing Address

**Please make sure to provide the correct mailig address. An incorrect mailing address could result in your giftcard(s) being lost.**

Mailing Address 1* :

Mailing Address 2 :

City* :

State/Province/Region* :

Postal Code* :

Country* :AfghanistanAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrazil DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCyprusCzech RepublicKoreaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaEuropean CommunityFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaoLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNiueNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KosovoRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoTome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandThe former Yugoslav Republic of MacedoniaThe former The former-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited Republic of TanzaniaUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaViet NamYemenZambiaZimbabwe

Recipient Name* :

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Credit Card Information

VISA Master American Express Discover JCB

Card Number* : - - -

Expiry Date* :Month: 　/　Year:

Card Holder Name* :

CVV / Security Code* :What is CVV?

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Billing Information

Same as mailing
address? :Yes

Purchaser Name* :

Billing Address 1* :

Billing Address 2 :

City* :

State/Province/Region* :

Postal Code* :

Country* :AfghanistanAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBrazil DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCyprusCzech RepublicKoreaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaEuropean CommunityFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaoLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNiueNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KosovoRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoTome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandThe former Yugoslav Republic of MacedoniaThe former The former-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited Republic of TanzaniaUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaViet NamYemenZambiaZimbabwe

Email* :

Phone Number* : - -

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Additional comments/instructions for the restaurant regarding your order:

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Note:

• Please note we are not responsible for lost or stolen cards.

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Please only click the submit button once and do not click the back button or refresh the page until the order confirmation page appears.