Customer Registration Form

As a part of the Western Australian Government’s COVID safety plan we are required to maintain attendance records of all dine-in customers. Please fill in the below fields

(your information will only be used for contact tracing in the event of an outbreak)

Liquor Licence information Licence number: 6020053413 Class of licence: Tavern Name of licensee: Ambergold pty ltd Address of premises: 711 Newcastle Street, Leederville, WA 6007 Telephone: 0459 922 008 WARNING Under the Liquor Control Act 1988, it is an offence: • to sell or supply liquor to a person under the age of 18 years on licensed or regulated premises; or • for a person under the age of 18 years to purchase, or attempt to purchase, liquor on licensed or regulated premises.