701 A Main Street - Louisville, CO 80027
CREDIT CARD AUTHORIZATION FORM FOR PARTIES OF 11 OR MORE
I hereby authorize /por/ wine house to use my credit card to pay the deposit for the ____________________________Party of ______ guests on _______________ at __________
(Name for Reservation) (#Of Guests) (Date) (Time)
I understand that /por/ wine house will charge my credit card if I cancel within 48 hours of the
reservation or a “no show”. Deposit Amount= # of guests x $25 ____________
Credit Card Type:
____ Visa ____ Mastercard ____ Discover ____ AMEX Credit
Card Number: ______________________________________________________________________
Expiration Date: ______/_______ Security Code:_________
Cardholder’s Name: _______________________________________________ Card Holder’s Billing Address:
Phone number: ________________________ Email: ________________________________________
By signing this authorization form, you agree to the following:
- ❏ This reservation is for non-private dining, during regular hours for confirmed parties of 11-20 guests.
- ❏ Deposits are only collected if the reservation is canceled within 48 hours prior to the event or if any of the confirmed guests is a “no-show” the day of the reservation. The deposit is $25 per person.
- ❏ The Garden can only accommodate parties of 12 or less. The Terrace can only accommodate parties of 13-20.
- ❏ Parties over 20 guests can be accommodated in our upstairs private dining rooms, please contact Event Cordinator, at email@example.com.
- ❏ A 20% gratuity will be added to all large party reservations. Please be mindful of the arrival time. We can only hold your confirmed reservation 30 minutes past your reservation time unless we are notified in advance. After 30 mins, we will cancel the reservation and charge the deposit in full.
- /por/ wine house will cancel this reservation if this completed authorization form is not received within 48 hours of the reservation.
- ❏ Please use this card to pay the final bill.
- First Name: ________________________________ Last Name: _______________________________
- Signature: ______________________________________________ Date:_______________________