Click here for more information
about Group Prepaid Tickets.

This form is for our information only.
This is NOT a credit card purchase form.
We will contact you directly
to complete your purchase.

Perry's Smorgy Restaurants are open
365 days a year including holidays.

Prices are standard retail
and include Hawaii State Sales Tax:

Breakfast: $8.45 (price before tax)

Served from 7:00 a.m. to 11:00 a.m.

Lunch: $8.95 (price before tax)

Served from 11:30 a.m. to 2:30 p.m.

Dinner: $12.99 (price before tax)

Served from 5:00 p.m. to 9:00 p.m.

Sunday Brunch: $12.99 (price before tax)

Served from 11:30 a.m. to 2:30 p.m.

Required Fields are Shown in Dark Red

Your Name:

Name of Group:

Company Name:

Phone:

E-Mail Address:

After Arrival Contact Information

Hotel:

Hotel Phone:

Personal Cell Phone:

Arrival Date:

One ticket is required per meal per person.

Day

Date

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday:

Sunday:

Total Number of Tickets Needed:

Intended Payment Method

(Please Select One)

Cash or Traveler's Check

VISA/MasterCard/JCB

Electronic Funds Transfer (EFT)

Company Check:

(15-day advance receipt required)

Wire Transfer of Funds

CENTRAL PACIFIC BANK

220 South King Street

Honolulu, Hawaii 96815

Routing #121301578 to

Acct. #000198737

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