Private Dining Request FormPlease complete the form with as much information as possible. We’ll get back to you soon. Name * First Name Last Name Email Phone (###) ### #### Company Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Event * MM DD YYYY Time Number of Guests * Notes/Special Requests How did you find us? Friend told me Read about 112 online Read about 112 in magazine Read about 112 in newspaper Dined at 112 Attended Private Event at 112 Have you used 112 before for special events? Yes No Attended but didn't plan/host Thank you for your interest in private dining at 112 Eatery. We’ll be in touch with you soon to discuss your event.