Name _________________________________
					   
                    Address _________________________________
					
                            _________________________________

                       City _________________________________
					   
                      State __ Country __     Zipcode _______
					  
               Phone Number __________________________
			   
 Month/Day of Your Birthday __________________________
(for birthday benefit)

  Check for $10.00 enclosed ___
  
      Charge my credit card ___
                 MasterCard ___  Visa ___  Amex ___

               Name on card ____________________________
             Account number ____________________________
           Expiration date  ____________________________
 
                 Signature  ____________________________


Please print this application, and mail or fax it to:

Warren's Lobster House
11 Water St./U.S. Route 1
Kittery, ME 03904
Fax: (207) 439-8821

Allow 3-4 weeks for delivery. If you dine at
Warren's before your card arrives, just mention
it to your server.11 Water St./U.S.