Group table _______ Individual table ________

Social Table (large table with other couples) _________

Special instructions___________________

PAVILION GRILLE NEW YEARS EVE RESERVATION 2017

NAME ________________________________________

PHONE ________________________________________

ADDRESS ________________________________________

EMAIL ADDRESS ________________________________________ TIME ________

IF GROUP, TOTAL # AT TABLE ______

TABLE UNDER WHOSE NAME ________________

_______ @ $125.73 ($99.00 + $6.93 sales tax + $19.80 service charge)

Total $__________________
DINNER & DANCE 7:30 p.m. $ __________ 1 - $125.73
Includes 7% Sales Tax $ __________ 2 - $251.46
Includes 20% Service Charge $ __________ 3 - $377.19
$ __________ 4 - $502.92
$ __________ 5 - $628.65
$ __________ 6 - $754.38
$ __________ 7 - $880.11
$ __________ 8 - $1,005.84
Fax # 561-998-7564
There is a $10.00 per person cancellation fee.
Reservations are transferable but non-refundable after Wed., December 20th, 2017
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