Pizza Order Form - Pickup

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Pizza Order Form - Pickup

Category		Pizza Selection		Quantity		Total
*Pizza Selection 1:
Toppings 1:
Toppings 2:
Toppings 3:
Get a 2nd pizza?

*Pizza Selection 2:
Toppings 1:
Toppings 2:
Toppings 3:
Get a 3rd pizza?

*Pizza Selection 3:
Toppings 1:
Toppings 2:
Toppings 3:
Category		Drinks & Extras		Quantity		Total
Drinks:
Drinks:
Drinks:
Drinks:

Extras:
Extras:
Extras:

Sub-Total:
Tax (AZ 9.10%):
Grand Total:
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
*E-Mail:
Billing Information
*First Name:						Same name as on your card
Middle Initial:
*Last Name:
*Address Line 1:						Where your statement is mailed
Address Line 2:						Apt. or Suite No.
*City:
*State:
*Zip Code:
Phone:
Payment Information
*Payment Method:		Credit Card Cash on Pickup
*Card Number:						No dashes or spaces please
*Expiration Month:						From your card
*Expiration Year:						From your card
*Card Brand:
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