Application Form
Please fill out this form and fax us.
FAX NO: (831) 626-0941
Dear Customer,
Showing your Jack London "WILD" Card entitles you to a 10% Discount on ALL non-beverage items on your table's (1) check.
(Other Promotions will be linked to the "WILD" Card.)
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Customer 1
Name:
Company:
Birthday(MM/DD):
Mailing
Address:
State/Zip:
Phone No.:
Fax No.:
Email Address (Optional):
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Customer 2
Name:
Company:
Birthday(MM/DD):
Mailing
Address:
State/Zip:
Phone No.:
Fax No.:
Email Address (Optional):
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WE WILL SEND YOU YOUR WILD CARD & LATEST NEWSLETTER BY MAIL.
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