CATERING/GROUP DEPOSIT PAYMENT

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   Print this from out and Fax it in for credit card deposit payments.

    *Please check with Catering Dept. for availability before sending payments in.

Amy Ruth’s Restaurant

Credit Card Authorization Form

   Event Name: ______________________________

   Reservation Date: __________________________

   Reservation Time: ___________________________

   Credit Holder Information:

   Card Holder    Name______________________________________________________
   (Please Print)

   Type of Card__________________________________________________

   Account    Number________________________________________________________

   Expiration Date________________________

   Amount to be Charged $_________________

   Amy Ruth’s Restaurant is authorized to charge my credit card for the    above listed amount.

   Signature_________________________________________          Date________________

   *Please return to Amy Ruth’s Restaurant via fax #212-280-3109:
                   -Completed Authorization Form
                   -Photocopy of FRONT and BACK of credit card
                   -Photocopy of State Photo Identification