WE ARE OPEN:
Sun - Thu 11am -10pm
Fri - Sat 11am - 11pm
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LOCATIONS
MENU
Regular Menu
Lunch Special
PROMOTIONS
CATERING
PARTY PLANS
CONTACT US
ABOUT
Menu
LOCATIONS
MENU
Regular Menu
Lunch Special
PROMOTIONS
CATERING
PARTY PLANS
CONTACT US
ABOUT
CC AUTHORIZATION
CC AUTHORIZATION
Amount
Purchase order
Invoice
By
MasterCard
Visa
Amex
Discover
Credit Card
Card Expiration Date
Name on Card
Company
Card Billing Adress
Country
City
State
Zip
CVC Code(Visa /MC-3 digit code on back)
Amex-4 digit code on front
Authorization is also given to add the cost of related delivery charges to the charge amount
Yes
No
Phone
Fax
Email
Drivers License
Driver License State
Driver License Exp. Date
Please read the below before signing this Credit Card Authorization from:
By signing this request, I agree to pay the full amount charged to the credit card account for the purchase order number shown in this agreement. My signature is confirmation that the credit card information provided is accurate and that I am authorization to mkae purchases on the credit card account number listed. I will be fully responsible for any incomplete or fraudulent information that may cause this transaction to be delayed or void. I agree to all charges, cancellation and/or restock penalties. I also agree to not fill a charge back or dispute without notifying Las Vegas Cuban Cuisine, ahead of time in writing and allowing for resolution. Request for refunds or return must be submitted to Las Vegas Cuban Cuisine in writing in accordance with the return police blow.
Authorization Signature
Date
Printed Name
Send