credit card form — The Harvey House

credit card authorization

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Name of guest on reservation

First Name

Last Name

Date of reservation

MM

DD

YYYY

Notes

What would you like to send to the table?

Message

Amount approved

$

Gratuity

Your Information Below

Name

First Name

Last Name

Email

Phone

(###)

###

####

Credit Card

Card Number

Billing Address

Billing Zip

Expiration Month

Expiration Year

CVV