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Mother’s Day 2015 Booking Form
Date of Reservation:
Sunday 10 May 2015
Reservation Name:
Requested time:
12:00 / 12:30 / 1:30
Number of Guests:
Mobile Number:
Email Address:
Dietary Requirements:
CREDIT CARD AUTHORISATION
Full Food payment: $85 per adult / $30 per child
TOTAL: $_______________
Type of Card:
Visa
AMEX
Bank Card
MasterCard
Diners Card
Name of Cardholder:
Credit card number:
Expiry Date: _______/_______
Security Code (required for all cards): ______________
Signature of Card Holder:
I, __________________________, authorise Dedes On The Wharf to debit my credit card for full food payment of Mother’s Day Lunch.
I understand that my reservation will only be confirmed upon full payment, and that beverages will be charged on consumption
on the day. I acknowledge that cancellations will not be eligible for a refund.
I have read and agree to the above terms and conditions.
Signed: _____________________________________
dedesonthewharf.com.au
[email protected]
Phone: 02 8488 6155
Fax: 02 9252 8639
Dedes On The Wharf
Pier 2, 13 Hickson Rd
Walsh Bay, 2000
Nero CKD Unit Trust T/A Dedes On The Wharf Pty Ltd | ABN 58 381 837838
Date: __________________________