Gift Card Request

Purchaser Information

First Name

Last Name

Phone Number

Gift Card Amount

Credit Card Number

Expiration Date

CVV

Card Holder's Billing Address

Town / City

State

Zip Code

Recipient Information

Are we sending this Gift Card to the above information?

Yes No, please send to the below recipient

First Name

Last Name

Recipients Address

Town / City

State

Zip Code

Terms and Conditions

I authorize The White Sands (aka 1106 Ocean Ave) to apply the charges of the above-amount to my credit card. I understand that submitting this form will constitute a binding agreement for full payment for the above-specified charges.

Gift Card Request

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