| Attention to: |
_________________________________________________________ |
| Booking name: |
_________________________________________________________ |
Booking Date: |
_________________________ |
| Your name: |
_________________________________________________________ |
Your contact number: |
_________________________ |
| Credit Card Authorisation |
| Name of cardholder: |
___________________________________________________________ |
Card type:
(3% surcharge for AMEX & Diners) |
_________________________ |
| Card Number: |
___________________________________________________________ |
Expiry Date: |
__________________ |
Amount$ |
______________ |
| Signature: |
___________________________________________________________ |
Date: |
__________________ |
|
|
| "I have read and accept the Terms and Conditions of The Cowrie Exclusive and Corporate Catering." |
| Name (Printed): |
____________________________________________________________ |
| Signature: |
____________________________________________________________ |
Date: |
__________________ |
|
|
Please note: payment will not be processed or the booking confirmed until our Terms and Conditions are accepted.
If you would like a receipt sent please include your address below otherwise we will hold if for you until the date of your function. |
| Address: |
______________________________________________________________________________________________________ |
| Office Use |
|
| Payment processed: |
_____________________________________________________________ |
| Receipt sent: |
_____________________________________________________________ |
Date: |
__________________ |
|
|
| Processed by: |
_____________________________________________________________ |