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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‑
2261 E. Sample Road, Suite 2 Lighthouse Point, FL. 33064 Restaurant
(954) 941‑0418 Office (954) 941‑2348
Fax (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 FAX, 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
