pleas fill this form out and e-mail or fax it to the number/ address below to reserve your place
Local Three Kitchen&bar
3290 Northside Parkway, NW
Atlanta, Ga 30327
Fax (404) 968 2701
City, State & Zip
Event Date Time Room Event
6/9/12 7:00 Pm Bushwood Dinner
The technical stuff
Please fill in your information above and below to secure your dinner reservation in the Bushwood room on June 9th, 2012. We will hold your credit card on file. Your three course dinner will cost $49 plus tax and gratuity per person. Additional alcohol will be charged on consumption and added to your final bill.
All final payments are due at the completion of the event and must be paid in full with a valid credit card or cash.
WE REQUIRE ON FILE A MAJOR CREDIT CARD AS A GUARANTEE METHOD OF PAYMENT.
Credit card type: American Express Visa Mastercard Discover
Name on card Card number Expiration date
I give Local Three permission to use the listed credit card as payment for the reservation listed above.
Please fax or email the completed form to Carly Monroe: firstname.lastname@example.org, (404)968-2701 fax
"If you can fill the unforgiving minute
with sixty seconds' worth of distance run,"
Dyslexic not dumb pleas let me know if i need to correct one of my post
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