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321 Xenia Avenue | Yellow Springs, OH
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Front Desk: 937-319-0400
Ellie's: 937-319-0402
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Ellie’s
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Valentine’s Day Dinner
First Guest's Name
*
First
Last
Second Guest's Name
*
First
Last
Billing Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Seating Time
*
6:00 pm
8:30 pm
Product Name
First Guest soup choice
*
Shrimp Bisque
French Onion
First Guest entree choice
*
Filet of Grouper
Filet Mignon
First Guest side choice
*
Au Gratin potatoes
Rice pilaf
Second Guest soup choice
*
Shrimp Bisque
French Onion
Second Guest entree choice
*
Filet of Grouper
Filet Mignon
Second Guest side choice
*
Au Gratin potatoes
Rice pilaf
Add-Ons
Optional Add-Ons
Bottle of house wine
Bottle of Champagne
Bouquet of Seasonal Flowers
Wine Choice
White
Red
Total
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
Security Code
Cardholder Name
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