To order by fax or mail, print out the form below. If you are paying by check or money order, include it with the form and mail both to:

Brasa Grill Steakhouse
1300 West 9th Street
Cleveland, OH 44113

You may also order by phone at 216-575-0699. You can mail this form to the above address with your check or money order.  If you want to order our gift certificate by fax, complete the form and fax it to 216-575-1867. Be sure to include your credit card information. You may also stop by the restaurant and purchase gift certificates in person!

Order Form

Please fill in the amount of the gift certificate you would like to purchase.

Total: $________


First name: ______________________________

Last name: _______________________________

Email: ___________________________________

Phone: ___________________________________

Fax: _____________________________________

Address: _________________________________

City: ____________________________________

State: ___________ Zip: ________________

Card type: _______________________________
(Visa, Master Card, Discover, AMEX, Diners Club)

Card number: _____________________________

Card expiration date: ____________________

Card security code: ______________________
(optional, located on back of card)

Ship to: _________________________________



SHIPPING ADDRESS (if different than billing address, above)

Address: _________________________________

City: ____________________________________

State: ___________ Zip: ________________