Credit Card Authorization

HOURS: LUNCH: Tue – Fri starting at 11:30 am & DINNER: starting nightly at 5:00 pm

Credit Card Authorization

HomeCredit Card Authorization

You can fill out the authorization form below, or download it here to scan and email to Stella. To download our Private Events credit card authorization form click here.

Credit Card Authorization

To Stella Burlingame ATTN:

Last Name

Your First Name

Your Last Name

Date / Time

Phone/Mobile

I authorize Stella Burlingame to charge my credit card according to the details below. I guarantee full payment of the account as described

Yes

Amount to Charge $ (22% Gratuity will placed on all purchases except Gift Cards)

Please Attach a Copy of the Front & Back of your Credit Card

Front of Card

File Upload

Back of Card

Reason For Charge

Reservation First Name

Reservation Last Name

Reservation Date

Reservation Time

Charge to:

AMEX

Mastercard

Visa

Diners Club

Card Number

EXP

CSV

By Typing Your Name In here – You are signing this form to be processed.

CC Zip Code

Home/Mobile Phone

Work/Office/Secondary Number