Credit Card receipt form

Name*

Email Address*

Billing Address*

City*

State*

ZIP*

Day Phone Number*

Evening Phone Number*

Reservation Date*

Event/ Celebration*

I hereby authorize payment using my*

Credit Card Number*

CCV*

Please enter a number from 0000 to 9999.

Expiration Year*

Please enter a number from 22 to 99.

Expiration Month*

Please enter a number from 00 to 12.

Prefix _______ × No. of People ______ = Subtotal _______

Prefix*

No. of People*

Subtotal*

Subtotal + 20% Gratuity = _______ Subtotal + Tax _______ = _______

Gratuity*

Tax*

Subtotal + 20% Gratuity*

Grand Total*

Amount to Charge*

Balance Due day of Event*

Special Instructions

Replace With Menu

The issuer of the card identified above and on the attached page is authorized to pay the dollar equivalent of the items and services detailed above. I hereby promise that I am the person identified in the photo identification on the attached page and, as such, agree to pay for the aforementioned items and services together with any other charges due thereon subject to and in accordance with the agreement governing the use of such card.

A 50% fee will be held against your account as a deposit for prix-fix reservations. If you choose to use a different method of payment on the day of your event, your credit card will then be credited. Failure to notify us of a cancellation for your party 1 week prior to your reservation will forfeit the initial 50% deposit.

We offer savings at the point of sale when you pay with cash. If paying with a credit card, a 3.9% Credit Card processing fee will be applied.

RESERVATIONS FOR GROUPS OF 40 OR MORE REQUIRE 48 HOURS CANCELLATION ADVANCE NOTICE