Credit Card Authorization Letter

 New Years Eve December 31, 2015 Please sign the form below authorizing the purchase of one or more of the following New Year’s Eve packages; __________ ​
X ​
Dinner Only Package​
​
5pm – 7pm​
only @ $45.00 each (includes 1 Three Course Prix Fixe dinner and a Champagne toast) __________ ​
X ​
Kids Dinner Only Package ​
5pm – 7pm​
​
only @ $18.00 each (includes 1 Three Course Prix Fixe dinner) __________ ​
X ​
Dinner & Dance Package 8pm – 2016!​
@ $125.00 each (includes 1 Three Course Prix Fixe dinner, a dance ticket, Champagne toast at midnight, and party favours) __________ ​
X ​
Veuve Champagne Dinner & Dance Package 8pm – 2016!​
@ $600.00 (includes 4 Three Course Prix Fixe dinner, 4 dance tickets, Veuve Clicquot Brut Champagne) __________ ​
X ​
Cristal Champagne dinner & Dance Package 8pm – 2016!​
@ $900.00 (includes 4 Three Course Prix Fixe dinner, 4 dance tickets, Cristal Brut Champagne) __________​
x ​
Dance only​
admittance after ​
10pm​
@ $60.00 each Plus Applicable Taxes & Gratuity Your credit card will be charged the actual amounts plus taxes & gratuity on the night of the event. ​
Cancellations will not be accepted after December 29 at 4pm. ​
Reservations cancelled after this time will be billed for the full amount plus applicable taxes as indicated above. Credit Card Type: □ VISA □ Mastercard □ American Express Credit Card Number:​
________________________________________
Expiry Date:​
____​
/​
_____ Signature of cardholder: ​
_________________________________________ Cardholder Name (please print):​
______________________________________ Contact #: _________________________________________ Please return this authorization letter via email to ​
twist@turnerstevens​
.com Thank you in advance! Twist Martini Restaurant & Lounge 31-170 Jozo Weider Blvd, Blue Mountains, ON tel: 705-445-5000