CREDIT CARD AUTHORIZATION FORM

You may choose one of ordering options : Send this form by clicking the "Submit" button , print this form and fax it to number : 1-800-999-0000 of the address as follows: Rendezvous Cafe 999 Imaginative Boulevard, San Francisco, CA 94014

Please provide the following contact information for a delivery to your place:

Name
Organization¹
Street address
City
Phone No. Required *
E-mail or Fax ¹ Optional

Provide the favourite songs that you want to hear during your next visit at our coffee shop:

The song name: ¹
Reference No: (Click here)
Day & time it´ll be played

Please provide the ordering information of your beverage or snack food:

QTY DESCRIPTION (Please click here for details) Price
Plus Delivery charge ( if any )
Total:
  BILLING * Attention :
Credit card If you want to pay in advance
Cardholder name
Card number * Please fill out only the last five digits
Expiration date

Do you want to get a print-out from the song you have chosen? It's always free at your request if available:

YesNo

If you have any special order that is not listed in our menu and even requests for a service delivered to your place at the neighborhood area, please donot hestate to fill in this box. Also, sign here on the print-out in case you fax this form to us.

Enter the date of ... :

-- mm/dd/yy


Copyright © 2001 Rendezvous Cafe. All rights reserved. Last revised:Mar 18, 2001
ATTENTION: After pressing Submit Form button, we will try to contact you through your phone number to get the rest digits of your card. Your credit card information will be verified. A confirmation of your order will show up approximately 60 to 90 seconds. If you find all datas on this page is correct, please print out to keep it as your receipt. Otherwise, click the Back Arrow on browser's toolbar to review and edit your previous entries. Thank you for shopping at our online store.
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