Group table _______

Individual table ________

PAVILION GRILLE NEW YEARS EVE RESERVATION 2016

NAME

________________________________________

PHONE

________________________________________

ADDRESS ________________________________________
EMAIL ADDRESS _______________________ TIME __________________
TOTAL # AT TABLE ______ TABLE UNDER WHOSE NAME ________________
_______ @ $124.74

($99.00 + $5.94 sales tax + $19.80 service charge)

Total

DINNER & DANCE 7:30p.m.

Includes 6% Sales Tax
Includes 20% Service Charge

$__________________

$ __________
$ __________
$ __________
$ __________
$ __________
$ __________

1 - $124.74
2 - $249.48
3 - $374.22
4 - $498.96
5 - $623.70
5 - $748.44

Reservations are transferable but non-refundable after December 23rd, 2016

The Pavilion Grille is authorized to Charge my Credit card
Amount $____________

Visa _____ Master Card _____ AMEX _____

Card Number__________________________________
Exp Date_______

Code________

Signature ________________________________________________________________
PARTIES MUST BE PAID IN FULL TO COMPLETE RESERVATION