2234 1st AVE Seattle, Washington 98121

206.441.9360 www.local360.orgMEZZANINE RESERVATION FORMReservation Contact Name:

Reservation Contact Phone Number:

Name/Phone Number of the Host of the Event (if different):

Company or Group Name:

Reservation Date:

Time: Contact E Mail Address:

Number of Guests:

(The guest count is guaranteed 3 days before the event date)Credit Card: #___________________________________ Expiration Date: ________________

Cardholder Name: _____________________________________ Billing Phone Number: __________________________________

Billing Address: ______________________________________________________________Terms and conditions: The cardholder agrees by their signature that all charges incurred by the Reservation are authorized to be charged to the Cardholders credit card. Final guaranteed guest count is due by March 23, 2015. There will be a $20 charge for each guest the night of the event that is less the confirmed guest number given.I have read the above and hereby authorize Local 360 to charge my credit card according to the policies stated.

Cardholders Signature:____________________________________________________

Visa, MasterCard, American Express & Discover Accepted

Thank you for your business.