Order Pizza for Pickup
Customer Information
Name:
Phone Number:
Email Address:
Pizza Size
Small ($10.00)
Medium ($15.00)
Large ($20.00)
Crust Type
Thin Crust
Regular Crust
Thick Crust
Toppings
Extra Cheese ($1.75)
Pepperoni ($1.75)
Green Pepper ($.75)
Mushrooms ($.75)
Spinach ($1.00)
Onions ($.75)
Total
Pizza size:
$0.00
Pizza topping(s):
$0.00
Grand total:
$0.00
Payment
Select Payment Type:
Pay at Restaurant
Pay Online
Name on Card:
Credit Card Type:
Issuer
Visa
MasterCard
American Express
Diners Club Card
Card Number:
Expiration Date:
Month
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Special Instructions:
Over 500 character limit
