| Print Out ( You may want to fill in important information and make copies ) Fax Order Form Please Call Us First 602-325-9334 (Please Fill out this form completely and fax to us . ) ( Please leave a number we can reach you if we have questions. ) This Form will not be faxed to the restaurant until Delivery Dine confirms the order. Today's Date _________ Desired Time ___________ ( 15 min. window ) Contact Name _____________________ Company ______________________ Delivery Address _________________________________________________ Suite # _______ City ______________________________ Zip ____________ Your Phone # ___________________________ Fax # __________________ Special Instructions for Driver ______________________________________ ______________________________________________________________ ______________________________________________________________ Payment Method ( Mark One ) Cash ___ or Company Check ___ Credit Card MC ___ VISA___ AMEX ___ The Restaurant You Want ________________________________ *Please consider the efforts of your mobile waiter, for they depend solely on your trips. Qty Entree / Item Persons Name _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ |