Briar Patch Bed and Breakfast
Gift Certificates E-Mail Order Form

Recipient:
(We need this information for our records)
Name:    
Address:
City:      
State:              Zip:
Phone:   

Donor:
(The Certificate will be mailed to you)
Name:    
Address:
City:      
State:              Zip:
Phone:   
Email (required by the server): 
Occasion of Gift:
(i.e. Wedding, Retirement, Christmas Gift)

Certificate Amount

 $

VA State & Local Taxes (10% - required)

 $

Overnight Postage

 $

TOTAL

 $

Yes, I have read the "fine print"
Note: This is not a secure server. If you choose not to enter your credit card information, the innkeeper will contact you to arrange payment.
Credit card type: 
Credit card number:
Name appearing on card:
Expiration date:

Comments: