Print this page out then

Mail the completed form to:
Quaintance-Weaver Restaurants & Hotels
324 West Wendover Avenue, Suite 320
Greensboro, NC 27408

OR

Fax to:
336-370-0965

Restaurant
Restaurant gift certificates are valid at the Green Valley Grill and any Lucky 32.
Quantity
Amount
Total
$10.00
$
$25.00
$
Hotel
Hotel gift certificates are valid at the O.Henry Hotel. All taxes included in prices listed below. For a detailed description of a package click its name. For customized hotel gift certificates please call 800-965-8259.
Quantity
Amount
Total
One Night's Stay
$258.77
$
$
$
$
TOTAL $
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Check Money Order Visa AMEX Discover
MC Diners Club

Account #:
Expiration Date:
Signature:
Shipping Address: (If different from above)
Name:
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