Take Out Order Form
Contact Information
Your Name:
Delivery Address:
Phone Number:
Email Address:
Menu Selection
Beverages
Water
Pink Lemonade
Iced Tea
Hot Tea
Coffee
Orange Juice
Apple Juice
Chocolate Milk
Hot Chocolate
Omelettes
Check which toppings you want:
Avocado
Bacon
Cheese
Ham
Mushrooms
Olives
Onions
Peppers
Sausage
Tomatoes
Sandwiches
Fried Egg
Western
Turkey Club
Ham Club
Roast Beef Club
Tuna Salad
Chicken Salad
Steak and Cheese
Coffee Shop Burger *NEW*
Choose a Delivery Method:
Delivery
Pickup
Select a Payment Method:
Cash
Credit Card
PayPal
Special Instructions: