Your Name				Date
	Contact Phone
	How would you like to get your voucher: (Choose one option)
	Fax Email Post
	Gift voucher value:		$
			Personal message to be printed on your gift voucher (optional)
	Payment details		Visa Mastercard Amex   Card No
			Expiry date
			Security code
	I hereby authorise Salsa Port Douglas to use my credit number for the payment of the gift voucher
	If you prefer to order your voucher by fax please print and return this form to Salsa Port Douglas by Fax: 61 7 4099 4922