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I, ___________________________________ hereby authorize SALENTO Restaurant to post the following charges to my credit card:

Charge: ______________________________________________

Reservation Name: ______________________________

Date:                                     Time:                                    Number of Guests:________

Telephone #    ________________________________________

Fax #     ________________________________________

Cardholder Name

 (As it appears on card):_______________________________________

Billing Address:________________________________________________

Credit Card #_____________________________Expiration________

Signature: ____________________________Date____/_____/____