Romantic Dinner for 2

Romantic Dinner for 2 - Information Form
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Date of Reservation*

MonthDayYear
Date
Time of Reservation *

Hour Minutes

AM/PM Option
Address of Reservation*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What type & name of location?*
Ex: hotel - Embassy Suites
What’s the special occasion? *
(Birthday, anniversary, proposal, date night, etc.)
Yes, but I prefer to use the tables that I haveYes, I’ll provide requested tables & chairsNo
If so, please provide the dimensions of the tables you're providing & photos of tables*
Upload photos of tables here

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Self-ServedServed by A Taste of Shilicous
Yes, 1 at each seatYes, just 1 for the tableNo
Porcelain/Glass plates and/or bowlsHigh Quality Plastic Plates and/or bowlsGlass stemwareHigh Quality Plastic cupsSilverwarePlasticwareLinen NapkinsPaper Napkins
What’s the color scheme of your romantic dinner? *
YesNo
How many bouquets would you like?*
Real flowersFaux flowers
For bouquet: What type of flowers would you like? *
YesNo
If so, how many & what colors?
HeliumNo heliumBoth
WineNon-alcoholic wineChampagneMimosasSparkling cider
For alcohol selections, upload ID *no ID, no alcohol*

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MoscatoRieslingRosèChardonnaySauvignon BlancPinot GrisPinot NoirPortZinfandelMerlotCabernet SauvignonOther
Please list full menu *include drinks and/or desserts, if needed**
Allergies?*
Any Special Request?
Signature*

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Romantic Dinner for 2 - Information Form