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I,
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, hereby authorize
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Bocelli Restaurant to charge my credit card for
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e.g. Lunch, Dinner, Dessert, Wine
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on
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at
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under the reservation in the name
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Date: 01/01/10 e.g.
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Time: 1:00pm e.g.
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of
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party of
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# of Guests
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Message for your guest(s)
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e.g. Happy Birthday, Happy Anniversary, etc
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Credit Card Type:
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Visa, Mastercard, Discover, American Express
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Credit Card Number:
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e.g. 04/10
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Expiration Date:
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Cardholder's Name:
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Telephone Number:
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E-mail:
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*All fields require an entry
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