1921 El Camino Real - Palo Alto, CA 94306
Tel: (650) 321-6798   Fax: (650) 321-6825   Email: sundancemine@aol.com

I, ___________________________________ , authorize Sundance The Steakhouse to

charge my credit card in the amount of $ __________________________ dollars.

Type of Credit Card: ____________________________________________________

Name as it appears on Credit Card: _________________________________________

Credit Card #: _________________________________________________________

Expiration Date: ________________________________________________________

Authorizing Party’s Telephone #: (          ) ____________________________________

Authorizing Party’s Fax #: (          ) __________________________________________

Signature: ______________________________________________________________

If this Pre Pay Form is received on a Monday through Friday, your Gift Certificate will be
processed and sent via regular mail within 48 hours of receipt.

Gift Certificate To: _______________________________________________________

Gift Certificate From: _____________________________________________________

Message up to 6 words: ____________________________________________________
(example: Happy Birthday / Happy Anniversary / Happy Holidays, etc.)

Mail Gift Certificate To: ___________________________________________________

                         Address: _______________________________________

                                       _______________________________________

                                       _______________________________________