Charity/Organization_____________________________________
Contact Name__________________________________Tel:____________________
Address:______________________________________________________________
_______________________________________________________________
Tax ID #_____________________________
Charity nights are offered on Thursdays only – excluding holidays.
Date Requested:________________________________________________
Alternate Date:__________________________________________________
The “fine print”
Diners must mention the name of the charity for their purchases to be included in total sales eligible for the 10% donation.
Lucy’s Table is open 11:00 am to 4:00 pm for lunch, Social Hour is 4:00 pm to 6:30 pm and Dinner starts at 5:00 pm.
Gratuity and valet parking are excluded from the program.
Fax completed form to 503-274-7122
We will contact you shortly to confirm your date.
