Credit Card Authorization Form
To order Café Epi gift cards, please print this form, complete the required information
I(printing clearly) and either fax to 650-328-4822 or mail the form to us at:
Café Epi , 405 University Avenue in Palo Alto, CA 94301
Please note that gift cards are not redeemable for cash.  We do not offer overnight delivery 

Purchaser Information

Name:

E-mail:

Address:

City: State Zip

I (print name) Hereby Authorize Café Epi

to charge my credit card for

the purchase of gift card in the amount of $

                *Please note that all mailed gift cards will be mailed Certified Mail

Payment Information

Name as it appears on the card:

Card Holder Signature:

Card Type: Master, Visa, Discover

Card No:

Expired date:

* Please include a front and back photo copy of the card used.

Recipient Information

Recipient Name:

Address (if mailed):

City: State: Zip: