French Restaurant Week® NEW YORK July 2- 15, 2018 BILLING ADDRESSCompany Name*Primary Contact*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code LISTING ADDRESSRestaurant Name*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Website Open Table® Member:*YesNoPRIX FIXE MENU OPTIONSAs a participating restaurant of French Restaurant Week® 2018, I will offer a prix- fixe menu option(s)* to customers and inform them of this special offer during this week.$17.89 BAR MENU: Amuse Bouches & Drink Weekdays Saturday Sunday None *Taxes and gratuities are not included$25 LUNCH MENU OPTION 1: 2 Courses & Drink Weekdays Saturday Sunday None *Taxes and gratuities are not included$25 LUNCH MENU OPTION 2: 3 Courses Weekdays Saturday Sunday None *Taxes and gratuities are not included$38 DINNER MENU OPTION 1: 2 Courses & Glass of Wine Weekdays Saturday Sunday None *Taxes and gratuities are not included$38 DINNER MENU OPTION 2: 3 Courses Weekdays Saturday Sunday None *Taxes and gratuities are not included$178.90 DINNER MENU - Menu for 2 guests & Bottle of Wine Weekdays Saturday Sunday None *Taxes and gratuities are not includedPROMOTIONAL PICTURESReproduction rights:* I certify that the pictures uploaded on this form are our property, and authorize MPB Agency, LLC to use the pictures for promotional purposes. Upload Pictures & Artworks Drop files here or Accepted file types: jpg, gif, png, pdf. PRICE LIST(Select one option)* RESTAURANT PARTICIPATION FEE: RESTAURANT PARTICIPATION FEE + HOMEPAGE FEATURING 2 WEEKS ADVERTISING BOX 300x250 (Select one option)*TOTAL AMOUNT DUE: $0.00 PAYMENT METHODCredit Type:*VisaMastercardAmexCredit Card Number:*CVV Number:*Expiration Date (MM/YY):*Name on the credit card:*Zip Code:*CODEReserve space by May 21th 2018 to be listed on OpenTable® dedicated page.