Phone Number - Hacienda Colorado

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					Please print the following form and complete the information. Return the signed copy by fax to (303) 399-4379
or mail to the address listed below.

Name:                                                    Date:                      Phone Number:

Credit Card        American Express             Visa        MasterCard        Discover

Name on Card:

Card Holder Address (for copy of receipt):

Credit Card Number:

Expiration Date:

Signature:

Shipping:
FedEx Standard Overnight $20.00              Note: We cannot FedEx to a P.O. Box.   US Postal Mail Service no charge.
FedEx 2 Day $15.00
FedEx 3 Day $12.00

Gift Card Amount:

Shipping Charge:

Total Due:

Gift Card Notes:

Mail to:

Street Address:

City:                                                      State:

Phone Number:                                              ZIP Code:

Please ensure that someone is available at the above address to sign for your gift card. In some areas a gift card
may take up to two weeks for delivery.
Fax completed form to (303) 399-4379

or mail to:
Hacienda Colorado
Gift Card Department
1720 S. Bellaire Street, Suite 520
Denver, CO 80222

				
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posted:1/26/2013
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