Millrose Restaurant Phone: 847-382-ROSE
and Brewing Company
45 Barrington Road Fax: 847-382-7693
South Barrington, IL 60010
Millrose Restaurant: Gift Certificates Fax Form
1. Please enter QUANTITY of each denomination desired.
$25: $50: $75: $100:
2. Gift Certificates will be shipped Certified Mail for $5.00
Total: $ Please Note: Your order will be processed the next business day.
Billing Information: Shipping Information:
First Name: MI: Please Note: A signature will be required upon delivery.
Last Name: ❑ Ship to the billing address.
Company: ❑ Ship to a different address.
Please complete the shipping form below.
Street Address: We require a street address - No P.O. Box.
Suite or Apartment #: First Name: MI:
City: State: Zip: Last Name:
Phone Number: Company:
Email Address: Street Address:
Credit Card: Suite or Apartment #:
Number: City: State: Zip:
Exp. Date: Month: Year:
Gift Message: (up to 10 words)
Please note: Messages will only appear if sent directly to the recipient. Gift messages will NOT be written if being sent the purchaser.