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Cap's Place, Inc.
d/b/a
CAP'S PLACE
ISLAND RESTAURANT
SEAFOOD
SPECIALTIES SINCE THE 1920's
Dock Located
‑2765 N.E. 28th Court
Lighthouse Point,
Florida 33064
Mailing Address‑
P.O. Box 5969, Lighthouse Point, FL. 33074
Restaurant (954)
941‑0418 Office (954) 941‑2346
www.capsplace.com
capsPlaceEmail@AOL.com |
CREDIT CARD AUTHORIZATION FOR GIFT CERTIFICATE
FOR YOUR CONVENIENCE, WE ACCEPT THE FOLLOWING CREDIT
CARDS FOR PURCHASES.
IF YOU WISH TO AUTHORIZE A PURCHASE ON A CREDIT CARD, PLEASE PRINT THIS FORM
AND HANDWRITE OR TYPE INFORMATION. THIS IS NOT A ON SCREEN FILL
IN FORM -PLEASE PRINT OUT FORM ON REGULAR PRINTER, FILL IN THE BLANKS
SEPARATELY. THEN EMAIL or MAIL COMPLETED FORM.
CREDIT CARD
TYPE: VISA MASTERCARD AMEX
NAME OF PERSON
SUBMITTING REQUEST:__________________________________________
ADDRESS:_______________________________________________________________________
PHONE NO: (____)
__________ FAX NO: (____) _______________ EMAIL _____________________________
CREDIT
CARD NUMBER ______________________
EXPIRATION DATE (MM/YY):
____________
NAME EXACTLY
AS IT APPEARS ON CARD
_________________________________________
IMPORTANT!!! WE
MUST HAVE A READABLE, LEGIBLE COPY OF YOUR CREDIT CARD.
IMPRINT OR PHOTOCOPY YOUR ACTUAL CREDIT CARD IN THE SPACE PROVIDED BELOW.
PLEASE CHARGE MY
CREDIT CARD, LISTED ABOVE, FOR THE AMOUNT OF $_________________
FOR THE PURCHASE OF
________________________________________________________________
_____________________________
________________
AUTHORIZED SIGNATURE DATE
