HTML Preview Restaurant Menu Order Form Sample Format page number 1.
USE THIS FORM WHEN ORDERING FROM OUR RESTAURANT MENU
FOR DELIVERY (24 hours notice) : _________ FOR PICKUP: ____________
Company Name: __________________________________________ Your Name: _________________________________________
Date: ______________________ Time: ________________Phone:____________________________Fax: ____________________
Delivery Location:_____________________________________________________ Meeting: ________________________________
Billing Information: Bill Us: __________ P.O. # / Cost Center: _________________________ Will Pay: ___________________
Payment: Credit Card # ______________________________________________________________ Expires: ______ / ________
If this is for pickup, please call to confirm we have received your fax
Do You Want ? 1 _____ (included) or 2 ______ Cookies per person (add $.75)
Do You Want ? Chips with Sandwich Orders No _____ Yes _____(add $1.00)
Do You Want ? Beverages? No _____ Yes _____(add $2.00)
NAME ORDER SPECIAL INST. BEVERAGE
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Rick’s On Second
619 W Second St. Antioch, Ca 94509
FAX TO: (925) 757-3876
PHONE: (925) 757-5500