CREDIT CARD AUTHORIZATION FORM FILL AUTHORIZATION FORM RECEIPT REQUEST INQUIRY FILL INQUIRY FORM CREDIT CARD AUTHORIZATION FORM Send Your Message to*Avalon <avalon@rumiskitchen.com>Sandy Springs <sandysprings@rumiskitchen.com>DC <dc@rumiskitchen.com>Private Dining <privatedining@rumiskitchen.com>Name on Event* Date of Event* MM slash DD slash YYYY Purpose of The Form* dine in on site catering delivery gift card other Other Purpose of The Form Zip Code of Billing Address* Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number * Expiration Date * Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code * Cardholder Name * Contact Phone Number*Contact Email Address* Amount to Charge ($)* I hereby give Rumi's Kitchen permission to pay for the amount with the credit card number given Upload Your Photo ID* Drop files here or Select files Accepted file types: jpg, png, Max. file size: 50 MB, Max. files: 4. Max 4 Files,Allowed File Types: JPG,PNGDate* MM slash DD slash YYYY Receipt Request Inquiry Send Your Message to*Avalon <avalon@rumiskitchen.com>Sandy Springs <sandysprings@rumiskitchen.com>DC <dc@rumiskitchen.com>Date of Visit* MM slash DD slash YYYY Name of The Reservation* Last 4 Numbers of Credit Card* Server’s Name* Check Number* Charge Amount*Contact Name* Contact Email Address* Contact Telephone Number*
