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GLENELGPIER.COM.AU F U N C T I O N S 18 HOLDFAST PROMENADE, GLENELG SA

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  • G L E N E L G P I E R . C O M . A U

    F U N C T I O N S

    1 8 H O L D F A S T P R O M E N A D E , G L E N E L G S A

  • CANAPÉS

    FRESH COFFIN BAY OYSTERSNatural, lime caviar (GF)Kilpatrick, Barossa bacon, Worcestershire (GF)Tempura battered, jalapeno aioli

    ASSORTED SUSHI wasabi, pickled ginger, soy (GFA)

    STEAK TARTARE PASTRY CUP 36° eye fillet, capers, shallots, cornichons, lemon (GFA)

    BEETROOT AND VODKA SALMON GRAVALAX horseradish cream, poppy seed bark (GFA)

    PROSCIUTTO CROSTINI fig, mint, balsamic (GFA)

    RARE 36° BEEF CROSTINI caramelised shallot, blue cheese aioli (GFA)

    PETITE CHICKEN SALAD peach, almond, salad greens (GF)

    PETITE THAI BEEF SALAD rice noodles, fresh herbs, chilli soy (GF)

    PETITE SA PRAWN SALAD iceberg, gazpacho, lemon (GF)

    PORCINI MUSHROOM ARANCINI black truffle, aioli, pecorino (V)

    BUTTER NUT PUMPKIN AND BURNT SAGE BUTTER ARANCINI fresh basil pesto, pecorino (V)

    SPICED BEETROOT AND BASIL ARANCINI (VE)

    HOUSE DUCK AND VEGETABLE SPRING ROLL chilli soy

    HOUSE VEGETABLES SPRING ROLL dipping sauce (V)

    PREMIUM BEEF SKEWER thai peanut dipping sauce (GF)

    CHICKEN SKEWER thai peanut dipping sauce (GF)

    PULLED PORK SLIDER slaw, bourbon bbq sauce, brioche

    MAYURA STATION WAGYU SLIDER provolone, pickle, ketchup, brioche

    LA VERA HALOUMI SLIDER chilli hummus, salad greens, brioche (V)

    CRISPY CHICKEN SLIDER chipotle, iceberg, brioche

    TASMANIAN PREMIUM BEEF PIE ketchup

    CHICKEN AND LEEK SAUSAGE ROLL pecorino, caraway, tomato relish

    PORCINI MUSHROOM QUICHE (V)

    FRIED CHIPOTLE CHICKEN iceberg, aioli (GFA)

    FISH AND CHIP CONE crumbed SA Garfish, chips tartare, lemon (GFA)

    STEAM BUN crispy pork, Asian salad, chilli soy

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    Per person4 items 246 items 358 items 45

    10 items 54

  • PLATTERS

    PIER TASTING PLATTER | 120 House dips, dukkah, olive oil, marinated olives, Szechuan squid, mushroom arancini, cured Salumi meats, warm breads (GFA)

    ANTIPASTO PLATTER | 110 Salumi meats, charred vegetables, marinated olives, Persian feta, house dips, warm breads (V, GFA)

    DIPS PLATTER | 85 (V, GFA, VEA)Capsicum, basil, almondOlive tapenadeCaramelised onionWarm breads

    SANDWICH PLATTER | 99 choice of (GFA)Roasted pumpin, chick pea, basil, lettuce (V)Chicken, chive, mayonnaise, lettuceHuon smoked salmon, dill, red onionBarossa ham, provolone, tomatoSalumi salami, olive, roasted peppers, lettuce Roasted zucchini, red peppers, pumpkin, basil pesto (VE)

    PIZZA PLATTER | 99 choice of (GFA)Pulled pork, bourbon bbq sauce, Swiss brown mushroomsConfit garlic, thyme, mozzarella (V)Margherita, heirloom tomato, garlic, mozzarella, fior de latte, basil (V)Calabaza, smashed pumpkin, toasted pine nuts, thyme, fetta (V)Prosciutto, Adelaide blue, shaved pear, rocket Charcuterie, double smoked leg ham, Spanish sausage, sopressa, caramelised onion Crispy sambal duck, sweet soy, asparagus, toasted shallots Harissa spiced prawns, Spanish sausage, chilli flakes, rocket, lemon Vegetarian, basil pesto, charred capsicum, eggplant, zucchini, onion (V)Pesto chicken, caramelised onions, mushroom, roasted peppers, feta

    LA VERA CHEESE PLATTER | 130 Adelaide blue, brie, vintage cheddar, house nuts, quince jam, dried fruits, lavosh (V, GFA)

    FRESH SEASONAL FRUIT PLATTER | 120 Sliced fruits, Greek yoghurt (V, GF, VE)

    SEASONED WEDGES | 60 Sweet chilli, sour cream (V)

    DESSERT PLATTER | 125Pistachio macaronLemon and lime cheese cake, berry coulisChocolate and raspberry tart, double cream

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    Price per platterEach platter serves twenty people

  • PLATTERS

    FRESH COFFIN BAY OYSTERSNatural, lime caviar | 120 (GF)Kilpatrick, Barossa bacon, Worcestershire | 130 (GF)Tempura battered, jalapeno aioli | 130

    ASSORTED SUSHI | 90 wasabi, pickled ginger, soy (GFA)

    STEAK TARTARE PASTRY CUP | 85 36° eye fillet, capers, shallots, cornichons, lemon (GFA)

    PROSCIUTTO CROSTINI | 75 fig, mint, balsamic (GFA)

    RARE 36° BEEF CROSTINI | 75 caramelised shallot, blue cheese aioli (GFA)

    PORCINI MUSHROOM ARANCINI | 85 black truffle, aioli, pecorino (V)

    BUTTERNUT PUMPKIN AND BURNT SAGE BUTTER ARANCINI | 85 fresh basil pesto, pecorino (V)

    SPICED BEETROOT AND BASIL ARANCINI | 80 (VE)

    HOUSE DUCK AND VEGETABLE SPRING ROLL | 80 chilli soy

    HOUSE VEGETABLES SPRING ROLL | 75 dipping sauce (V)

    PREMIUM BEEF SKEWER | 120 Thai peanut dipping sauce (GF)

    CHICKEN SKEWER | 120 Thai peanut dipping sauce (GF)

    PULLED PORK SLIDER | 85 slaw, bourbon bbq sauce, brioche

    MAYURA STATION WAGYU SLIDER | 85 provolone, pickle, ketchup, brioche

    LA VERA HALOUMI SLIDER | 85 chilli hummus, salad greens, brioche (V)

    CRISPY CHICKEN SLIDER | 85 chipotle, iceberg, brioche

    PASTRIES | 75Tasmanian premium beef pie, ketchupChicken and leek sausage roll, pecorino, caraway, tomato relishPorcini mushroom quiche (V)

    FRIED CHIPOTLE CHICKEN | 75 iceberg, aioli (GFA)

    STEAM BUN | 80 crispy pork, Asian salad, chilli soy

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    Price per platterEach platter serves twenty people

  • SELECT SET MENU

    SHARED ENTRÉE

    PIER TASTING PLATTER (GFA)House dips, dukkah, olive oil, marinated olives, Szechuan squid, mushroom arancini,cured salumi meats, toasted breads ENTRÉE

    PORCINI AND TRUFFLE ARANCINI garlic aioli, pecorino (V)

    LIGHTLY SMOKED DUCK BREAST celery puree, pickled cucumber, cherry jus (GF)

    36° BEEF CHEEK mushroom, crème puff, parsnip puree (GF)

    SOUTH AUSTRALIAN GRILLED PRAWNS romesco, water cress, lime (GF)

    SALT LAKE PORK BELLY cauliflower cream, apple slaw, cider jus (GF)

    SOUTH AUSTRALIAN SZECHWAN SQUID chorizo crumb, salsa verde (GFA)

    SALT AND PEPPER TOFU asian greens, hoisin (VE, GFA)

    MAIN

    CRISPY SKIN ATLANTIC SALMON soft herb polenta, baby endive salad, horseradish cream

    SALT LAKE PORK NECK PIE crème puff, cauliflower puree, red wine jus

    200G 36° SIRLOIN potato mash, charred asparagus, chimmi butter, red wine jus (GF)

    FREE RANGE CHICKEN BREAST potato and pancetta gratin, capsicum coulis, water cress, red wine jus (GF)

    MAYURA STATION BRISKET RENDANG fragrant rice, coconut chilli sambal, naan bread (GFA)

    CHARCOAL GRILLED SALT BUSH LAMB RUMP Hahndorf chorizo, pumpkin, baby spinach, cauliflower cream, lamb jus (GF)

    HARRISA PUMPKIN SALAD brown rice, red cabbage, carrot, avocado, baby spinach, spiced chick peas, lemon vinaigrette (V, VE) TEMPURA ZUCCHINI FLOWER ricotta, pine nut, forest mushrooms, fresh herbs, rocket pesto (V)

    CHAR GRILLED SOUTH AUSTRALIAN WHOLE GARFISH basil, lemon crumb, Goolwa pippies, tomato, chilli, sauvignon blanc sauce

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    SELECT SET MENU OPTIONS1 : 1 | 50

    1 : 2 | 552 : 2 : 2 | 65 3 : 3 : 2 | 75

    Minimum bookings of twenty five, all events of more than fifty requires an alternate drop menu

  • SELECT SET MENU

    SHARED DESSERT

    LA VERA CHEESE PLATTERAdelalide blue, brie, vintage cheddar, house nuts, quince jam, dried fruits, lavosh (GFA)

    DESSERT PLATTERPistachio macaronLemon and lime cheese cake, berry coulisChocolate and raspberry tart, double cream

    DESSERT

    TOFU AND COINTREAU MOUSSE macerated berries, honey-less honeycomb (GF, VE)

    CHOCOLATE FONDANT vanilla bean ice cream

    CHOCOLATE TRUFFLES raspberry foam, toasted house marshmallow, honeycomb

    STICKY FIG PUDDING pecan brittle, gold leaf, toffee sauce, double cream

    BAKED LEMON TART macerated berries, house marshmallow, cream

    VANILLA BEAN PANNA COTTA sweet short bread, caramelised orange compote (GFA)

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    SELECT SET MENU OPTIONS1 : 1 | 50

    1 : 2 | 552 : 2 : 2 | 65 3 : 3 : 2 | 75

    Minimum bookings of twenty five, all events of more than fifty requires an alternate drop menu

  • CHRISTMAS SELECT SET MENU

    SHARED ENTRÉE

    PIER TASTING PLATTER (GFA)House dips, dukkah, olive oil, marinated olives, Szechuan squid, mushroom arancini,cured salumi meats, toasted breads MAIN

    CRISPY SKIN ATLANTIC SALMON soft herb polenta, baby endive salad, horseradish cream

    SALT LAKE PORK NECK PIE crème puff, cauliflower puree, red wine jus

    200G 36° SIRLOIN potato mash, charred asparagus, chimmi butter, red wine jus (GF)

    FREE RANGE CHICKEN BREAST potato and pancetta gratin, capsicum coulis, water cress, red wine jus (GF)

    MAYURA STATION BRISKET RENDANG fragrant rice, coconut chilli sambal, naan bread (GFA)

    CHARCOAL GRILLED SALT BUSH LAMB RUMP Hahndorf chorizo, pumpkin, baby spinach, cauliflower cream, lamb jus (GF)

    HARRISA PUMPKIN SALAD brown rice, red cabbage, carrot, avocado, baby spinach, spiced chick peas, lemon vinaigrette (V, VE) TEMPURA ZUCCHINI FLOWER ricotta, pine nut, forest mushrooms, fresh herbs, rocket pesto (V)

    CHAR GRILLED SOUTH AUSTRALIAN WHOLE GARFISH basil, lemon crumb, Goolwa pippies, tomato, chilli, sauvignon blanc sauce

    ROASTED TURKEY BREAST baby vegetables, herb stuffing, cranberry sauce

    DESSERT

    TOFU AND COINTREAU MOUSSE macerated berries, honey-less honeycomb (GF, VE)

    CHOCOLATE FONDANT vanilla bean ice cream

    CHOCOLATE TRUFFLES raspberry foam, toasted house marshmallow, honeycomb

    STICKY FIG PUDDING pecan brittle, gold leaf, toffee sauce, double cream

    BAKED LEMON TART macerated berries, house marshmallow, cream

    VANILLA BEAN PANNA COTTA sweet short bread, caramelised orange compote (GFA)

    TRADITIONAL CHRISTMAS PUDDING brandy custard, double cream, cherry

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    CHRISTMAS SELECT SET MENU OPTIONS1 : 1 | 55

    1 : 2 | 602 : 2 : 2 | 70 3 : 3 : 2 | 80

    Minimum bookings of twenty five, all events of more than fifty require an alternate drop menu

    Includes Christmas decorations and bon bon

  • DAY DELEGATE

    MORNING AND AFTERNOON TEA

    DIP POTScapsicum, cashew and basil, olive tapanade, crudities'

    PUMPKIN AND SAGE ARANCINIbasil pesto

    SAVOURY MUFFINScheese, bacon, zucchiniroasted capsicum, baby spinach and olive

    FRESHLY BAKED COOKIESAnzac biscuits Chocolate chip

    GLUTEN FREE COOKIESChocolate fruit and nut

    FRESHLY BAKED SCONEStraditional with whipped cream and strawberry jam

    FRESHLY BAKED SAVOURY SCONESpumpkin and mozzarella

    ASSORTMENT OF DANISH PASTRIES

    CHEESE AND CRACKERS La Vera brie, vintage chedder, nuts, dried fruits and lavosh

    QUICHESVariety of fillings

    HOUSE GRANOLA BOWLS berry compote, Greek yogurt (vegan with out yogurt, GF)

    ASSORTMENT OF MINI MUFFINSchocolate,berry,salted caramelBlueberry muffins , Gluten free option

    FRUIT CUPSseasonal chopped fruits, yougurt

    BRAIN FOOD TO KEEP YOUR FOCUS

    WARM HOUSE NUTS MARINATED OLIVESDIP POT AND CRUDITIES WHOLE FRUIT GRANOLA CUP

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    DAY DELEGATEFull Day | 65

    Half Day | 50

    One selection Morning and Afternoon Tea1 : 1 Light Working Lunch

    Extra selection item | 5Brain Food | 5 per person per item

    Includes: water, mints, paper, pens

    LIGHT WORKING LUNCH

    OPTION ONE

    SELECTION OF SANDWICHES (GFA)

    SALT AND PEPPER SQUID hot chips, garlic aioli (GFA)

    CRISPY CHIPOTLE CHICKEN STRIPS hot chips, lime aioli (GFA)

    MUSSAMAN LAMB CURRY steamed rice (GF)

    THAI GREEN CHICKEN CURRY steamed rice (GF)

    BEEF SLIDER cheese, pickle, ketchup

    HALOUMI SLIDER chilli hummus, slaw

    THAI FRIED RICE wok tossed vegetables, hokkien noodles (VEA)

    OPTION TWO

    HARRISSA PUMPKIN (GF, VE) brown rice, red cabbage, carrot, avocado, baby spinach, spiced chick peas, lemon vinaigrette ZESTY QUINOA (GF, VE) beetroot infused quinoa ,asparagus, sugar snaps, fresh peas, fennel, heirloom carrots, rocket, apple vinaigrette

    GARDEN SALAD (GF, VEA) heirloom cherry tomato, cucumbers, red onion, fresh herbs, local olives, Persian feta, mixed greens

  • LIGHT WORKING LUNCH

    OPTION ONE

    SELECTION OF SANDWICHES (GFA)

    SALT AND PEPPER SQUID hot chips, garlic aioli (GFA)

    CRISPY CHIPOTLE CHICKEN STRIPS hot chips, lime aiolo (GFA)

    MUSSAMAN LAMB CURRY steamed rice (GF)

    THAI GREEN CHICKEN CURRY steamed rice (GF)

    BEEF SLIDER cheese, pickle, ketchup

    HALOUMI SLIDER chilli hummus, slaw

    THAI FRIED RICE wok tossed vegetables, hokkien noodles (VEA)

    OPTION TWO

    HARRISSA PUMPKIN (GF, VE) brown rice, red cabbage, carrot, avocado, baby spinach, spiced chick peas, lemon vinaigrette ZESTY QUINOA (GF, VE) beetroot infused quinoa ,asparagus, sugar snaps, fresh peas, fennel, heirloom carrots, rocket, apple vinaigrette

    GARDEN SALAD (GF, VEA) heirloom cherry tomato, cucumbers, red onion, fresh herbs, local olives, Persian feta, mixed greens

    BRAIN FOOD TO KEEP YOUR FOCUS

    WARM HOUSE NUTS MARINATED OLIVESDIP POT AND CRUDITIES WHOLE FRUIT GRANOLA CUP

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    LIGHT WORKING LUNCH1 : 1 | 35

    Extra selection item | 5Brain Food | 5 per person per item

    Buffet style lunch including bread roll and butter

    Includes: water, mints, paper, pens

  • MORNING OR AFTERNOON TEA

    DIP POTScapsicum, cashew and basil, olive tapanade, crudities'

    PUMPKIN AND SAGE ARANCINIbasil pesto

    SAVOURY MUFFINScheese, bacon, zucchiniroasted capsicum, baby spinach and olive

    FRESHLY BAKED COOKIESAnzac biscuits Chocolate chip

    GLUTEN FREE COOKIESChocolate fruit and nut

    FRESHLY BAKED SCONEStraditional with whipped cream and strawberry jam

    FRESHLY BAKED SAVOURY SCONESpumpkin and mozzarella

    ASSORTMENT OF DANISH PASTRIES

    CHEESE AND CRACKERS La Vera brie, vintage chedder, nuts, dried fruits and lavosh

    QUICHESVariety of fillings

    HOUSE GRANOLA BOWLS berry compote, Greek yogurt (vegan with out yogurt, GF)

    ASSORTMENT OF MINI MUFFINSchocolate,berry,salted caramelBlueberry muffins , Gluten free option

    FRUIT CUPSseasonal chopped fruits, yougurt

    P ER

    GF - Gluten Free, GFA - Gluten Free AvailableV - Vegetarian, VE - Vegan, VEA - Vegan Available

    MORNING OR AFTERNOON TEAPer person per item | 15Extra selection item | 5

    Includes: water, mints, paper, pens

  • DRINK PACKAGES

    STANDARD

    Chain of Fire Shiraz CabernetChain of Fire Semillon Sauvignon BlancChain of Fire Brut CuvéeLight BeerGreat Northern Super CrispCarlton DraughtCarlton DryCiderSoft Drink

    PREMIUM

    Tomich 'Wing and a Prayer' Sauvignon BlancTomich 'Grace and Glory' ShirazTomich NV Woodside Vineyard Sparkling TRoséMoscatoStella ArtoisGreat Northern Super CrispCarlton DraughtCarlton DryCiderSoft Drink

    P ER

    DRINK PACKAGESStandard

    Three hour | 44Four hour | 49

    PremiumThree hour | 55

    Four hour | 59

  • SOMETHING A BIT DIFFERENT

    P ER

    Room Name

    Boardroom U-Shape Classroom Theatre Cabaret Banquet Cocktail

    Beachside 1 20 20 20 56 24 30 40

    Beachside 2 20 20 20 56 24 30 50

    Beachside 3 22 30 36 80 40 50 70

    Beachside 1 & 2 - - 40 85 48 60 90

    Beachside 2 & 3 - - 56 136 64 90 120

    Beachside 1, 2 & 3 - - 94 192 88 120 160

    Paradise & Beachside - - - 200 140 160 315

    Paradise & Beachside With Dance Floor

    - - - - 104 120 315

    Beachfront Function Room - - - - - 100 150

    Beachfront Function Room With Dance Floor

    - - - - - 80 150

    !

    ROOM DIMENSIONS AND CAPACITY

    Full Day Half Day

    Projector and Screen 225 175

    60 inch Smart TV on portable stand 225 175

    Projector Screen 40 40

    Whiteboard 50 50

    Flip Chart and Markers 50 50

    Lectern 40 40

    Cordless Microphone 100 60

    Laptop 150 100

    Powerpoint Remote with Laser Pointer 45 35

    AUDIO / VIDEO EQUIPMENT

    Fruit Bowl 50

    Lolly Jar 30 or 15 per table

    Sparkling Water all day 10 per person

    Barista made Espresso Coffee all day 10 per person

  • TERMS AND CONDITIONSAVAILABILITYIf through circumstances beyond the control of the Pier Hotel, the room hired becomes unavailable, the venue reserves the right to relocate the event to another room, within the premises. If the area cannot be made available to the hirer on the requested date, due to industrial dispute, fire, flood or any other act of God, the Pier Hotel shall not be liable for any loss, and/or injury suffered by the hirer, as a result of the unavailability of the venue.

    MINIMUM CHARGESA minimum charge on food and beverages is applicable to all private events. April to September - $5,000October to March - $7,000

    BOOKINGS / DEPOSITPlease be aware that bookings are not confirmed until a deposit has been received and the terms and conditions have been signed and returned. All deposits are non-refundable.

    SET-UP FEESA $395 set-up fee is applicable to all events. Monday to Friday Full Day event times 8am til 5pm, Half Day event times 8am til 12pm or 1pm til 5pm. Saturday and Sunday Full Day event times 8am til 4pm, Half Day event times 8am til 12pm.Earlier access is availalble on request.

    PAYMENTFull payment is required 14 days prior to your event date. Any extras that are required on the day of the event must be paid at the conclusion of the event, prior to the client departing. If there is an outstanding amount owed after your event, the Events team reserves the right to charge the credit card on file.

    MENU AND BEVERAGESFood and beverage selections must be finalized at least 14 days prior to your event. This needs to include any special dietary requirements (i.e. vegetarian, gluten free, etc). All food must be served before 10pm, menu and prices are subject to change.

    No outside catering is allowed to be brought onto the property (the only exception to this is a celebration cake where a $45 cake cutting fee is applicable), nor is any food or beverage allowed to be taken from the Pier Hotel. All celebration cakes must be assembled by the client or a designated person on their behalf and if the cake is required to be cut, this can only be done by Pier Hotel staff (due to OHS, guests are not allowed to cut and distribute themselves) and a fee will apply.

    SECURITYAll 18th and 21st celebrations with guests numbers over fifty are required to have a minimum of two security guards at $50 per hour.

    CANCELLATIONS In the unfortunate event of a cancellation within 14 days of the event date, the client will be charged the full price for the event as per the Event Order, or as agreed by the Events team.

    EQUIPMENT HIREAll equipment hire provided by the Pier Hotel is at an additional cost. If providing your own entertainment such as an iPod, DJ or band, you are required to supply all necessary cords, speakers and associated equipment.

    NOISE & ALCOHOL CONSUMPTION OUTSIDEFrom 12am, no patron is to be outside, this includes for smoking. External doors must be closed from 12am.

    CLEANING & BREAKAGESConfetti, table scatters, glitter cannons, smoke machines, dry ice, flower petals and rice grains are permitted, but need to be negotiated with your meetings and events coordinator before your event and may have and additional cleaning fee added.

    The client will be held responsible for any breakages or damage to any Pier Hotel property.

    P ER

    ACCEPTED BY THE CLIENT:

    I, (please print name) __________________________________________ have read the terms and conditions for the Glenelg Pier Hotel and confirm that the above information is correct and provide the relevant payment details to confirm this booking.

    Client signature: ______________________________________________ Date: ______________________________________________

  • CREDIT CARD AUTHORISATION

    Today's date:_______________________________________ Ammount to be charged: $__________________________

    Client's name: ________________________________________________________________________________________

    Phone number: _______________________________________________________________________________________

    Email address: ________________________________________________________________________________________

    Name of function: ____________________________________________ Function date: _________________________

    Function room: ______________________________________________ Time requested: _______________________

    Approx number of guests: ______________

    Credit Card details:

    Please tick:

    Visa Mastercard American Express

    Card number: ___________________________________________________________ Expiry Date: _________________

    Name on card: _______________________________________________________________________________________

    Cardholder signature: _________________________________________________________________________________

    P ER