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Required fields are marked with a (*)

1. *Name:


2. *Address:


3. *Telephone Number:


4. *Email Address:


5. *Credit Card # (sorry we do not accept Amex)


6. *Expiration Date:


7. *Package Type:


8. *Dates Requested:


9. *Which evening would you like to dine at the Bistro and what time?


10. Special Notes:


11. Add a Bottle of Champagne in Silver Chiller With Two Glasses


12. When Would You Like The Champagne Delivered To Your Room?



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