C:\Users\User\Desktop\Grand - Customer Reservation Form- 2019.doc

The 2019 New Year’s Eve Celebration at the Signature Grand™

Customer Reservation Form Telephone # (954) 424-4000 / Fax # (954) 424-2608

Please reserve seats under the following names:

Please print & note if under 21 years old

1. _________________________ 2. _________________________ 3. _________________________ 4. _________________________ 5. _________________________ 6. _________________________ 7. _________________________ 8. _________________________ 9. _________________________ 10. ________________________ 11. _________________________ 12. ________________________ _____ Adult Guests @ $140.00 (plus Sales Tax =$148.40) .........$ __________ _____ Child Guests @ $125.00 (Plus Sales Tax =$132.50) ............$ __________ NAME: ADDRESS: CITY: STATE: ZIP CODE: WORK #: Fax #: HOME #: Fax #:

CELL #: Email: What Age Group would you be in?

How did you hear about our NYE Party?

C:\Users\User\Desktop\Grand - Customer Reservation Form- 2019.doc

Method of payment Enclosed is my personal check:________ Please charge this to my Amount Charged: American Express Card # Exp. Date: Visa # Exp. Date: cvc# MasterCard # Exp. Date: cvc# ______________________________ Authorized Signature Name on Card

Additional Method of payment

Enclosed is my personal check:________ Please charge this to my Amount Charged: American Express Card # Exp. Date: cvc# Visa # Exp. Date: cvc# MasterCard # Exp. Date: cvc# ______________________________ Authorized Signature Name on Card

Comments or requests

1. All tables will be set for 12 guests. If you reserve less than 12 guests, we will seat you with nice people. 2. Tickets are not refundable after December 20, 2019 3. Prices per adult are $140.00 (Sales Tax is not included). 4. Prices for guests under 21 are $125.00 (Sales Tax is not included) 5. Personal check, American Express, Visa and MasterCard may be used to make payments.