Pre-Pay Form


Reservation Info:
Reservation Name:
Reservation Date:
Reservation Time:
Contact Info:
(you will be contacted by a reservationist to confirm)
Your Name:
Phone #:
Email:
Prepay Details:
Prepaid item or Amount:
(Please specify what you would like to pre-pay: dinner, bottle of wine, dessert, dollar amount etc.)
20% gratuity will be added for the service
Prepay to be addressed to:
Prepay to be addressed from:
Message to Guest:
Special instructions: present notice of gift at:
  Beginning of meal
End of meal
Payment Info:
Credit Card Type
Full Name on Credit Card
Credit Card #
Expiration (MM/YYYY)
Card ID What is this?

I authorize Waterbar Restaurant to charge my credit card account for the amount of the specified item(s) plus tax and gratuity.

Name:
Date:
Send a copy of receipt: No
Yes
Mailing Address For Receipt: