Name:   __________________      Date: __________     Time:__________


Type of Party:_____________      Phone#  ________     Fax#___________


Number of Guest:__________      Deposit _________    Received By:____


Table Clothes $7 each (Yes or No)          Entertainment (Yes or No)

Room Set Up:

Food Out:                                                           Bar Set Up: Open  Cash  Tab


Cold Food                                                           Hot Food







Price Per Person

Food                                                                        Food w/open bar

Customer agrees that Buffet Food is not for take out

Head count will be taken through the duration of the party

Manager will present the final head count to the customer before the final bill is presented

Customers agree that Clancy’s reserves the right to hold two or more tables for restaurant over flow if the customer has under fifty people in their party

Customer Sign___________________ initial_____

Manager Sign ___________________  initial_____