CREDIT CARD AUTHORIZATION FORM FILL AUTHORIZATION FORM RECEIPT REQUEST INQUIRY FILL INQUIRY FORM CREDIT CARD AUTHORIZATION FORM Send Your Message to*Avalon <[email protected]>Sandy Springs <[email protected]>Private Dining <[email protected]>Name on Event*Date of Event* Date Format: MM slash DD slash YYYY Purpose of The Form*dine inon site cateringdeliverygift cardotherOther Purpose of The FormZip Code of Billing Address*Credit Card* American ExpressDiscoverMasterCardVisa Card Number * Expiration Date * Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 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 Accepted file types: jpg, png. Max 4 Files,Allowed File Types: JPG,PNGDate* Date Format: MM slash DD slash YYYY Receipt Request Inquiry Send Your Message to*Avalon <[email protected]rumiskitchen.com>Sandy Springs <[email protected]>Date of Visit* Date Format: 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*
