DEPOSIT FORM

First Name*
Last Name*
Booking or Company Name*
Email Address*
Phone Number*
Booking Reference No
Venue*
Booking Date*
Date Format: DD slash MM slash YYYY
Booking Time*

: HH

MM
No. Of Adults*
Please enter a number greater than or equal to 0.
No. Of Children
Please enter a number greater than or equal to 0.
Amount to be charged*

( Deposits / Full Payments )
Menu selection & price per person
Credit Card*

American Express
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Terms and Conditions*
- I Agree to the Terms & Conditions
By ticking the above you accept the terms and conditions laid out here

NICK’S RESTAURANT AND BAR GROUP

T: 1300 989 989
F: (02) 9264 8448
info@nicksgroup.com.au