Banquet Request Form

Takeout   603-623-3182
Functions   603-666-9893
Restaurant   603-669-6890

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Sun-Thurs 11am - 11pm
Fri-Sat 11am - 12am
Takeout opens at 8am

Please complete the following form or email us at puritanbackroom@comcast.net.

Required fields are denoted by a *

* Function Type:
* Max # of Guests:
* Date of Event:
* Time:
* First Name:
* Last Name:
Address:
City:
State:
Zip:
* Email:
* Phone:
	I'd like information about the function rooms and conference center
	I'd like to be on the mailing list

* Comments/Question:

Name

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	Open Daily At 11:00 am Serving Complete Menu Until 11:00 pm Sun-Thurs, 12:00 am Fri-Sat Takeout Open Daily at 8:00 am © 2010 The Puritan Backroom · 245 Hooksett Road, Manchester, NH 03104 · Phone: 603-669-6890 · Fax: 603-623-3788