CREDIT CARD AUTHORIZATION

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CREDIT card AUTHORIZATIONPlease provide us with the following information and fax back to (212) 594-6371 so that we may process your order quickly and AddressCredit CardAmexVisaMasterCardDiner s ClubDiscoverCredit card NumberExpiration DateCard Identification Numberfour flat digits number on the front of amex card or three digit number on the signature area for other cardsDescribe Authorized Use and CostTotal Purchase Allowedbefore applicable service fee (15%-20%) and before sales tax (this does not apply to gift certificates)I hereby authorize Keens Steakhouse to charge the above allowed total purchase ,plus fees and taxes, to my CREDIT card s SignatureDateTelephone NumbersGift cards are processed within 48 hours of receipt of this form and are mailed using the US Postal Service. If you have any questions, please call (212) 947-3636BAR RESTAURANT PRIVATE PARTIES72 West 36 Street New York, NY 10018 Reservations (212) 947-3636DayEvening

CREDIT CARD AUTHORIZATION Please provide us with the following information and fax back to (212) 594-6371 so that we may process your order quickly and efficiently.

  Direct, Card, Authorization, Credit card authorization