VIP Bottle Service Request Form

Rebel Bottle Service ONLY - Asylum ($1,000)

Sun. Oct. 31 @ Rebel
What's Included: To Purchase Bottle Service Please click the Reserve button below and someone from Rebel will contact you! | Tax and Tip Not Included

Deposit is required

Please fill out the form below to request VIP & Bottle Service. A representative from the club will contact you to confirm your booking.

*Name (first & last) *Best Time to Call Best Way to Contact You

*Event Date

*Email Phone Number Number of People

*8+4=

Additional Notes Privacy Policy

VIP Bottle Service Request Form

Rebel Bottle Service ONLY - Asylum ($1,000)

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