Fill out and submit this form to request a Gift Card from Brussels Bistro. Once we receive this information, we will call you to process your payment over the phone. We will then securely mail the Gift Card to the address provided.

Name (From) *
Name (From)
Name (To)
Name (To)
Personal note you would like to send along with the Gift Card (Optional)
Phone Number *
Phone Number
We will call you at this number to process payment
Location *
Mailing Address *
Mailing Address
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OR come in to one of our Locations to purchase a Gift Card.


Brussels Bistro

222 Forest Avenue

Laguna Beach, CA 92651


(949) 376-7955


M-Th 4p–10p

F 4p–2a

Sa 11a–2a

Su 11a–10p