TODAYS DATE_____________________________________________________
*CREDIT CARD #______________________________________*EXP________
# OF GUESTS_______________________________ *CIV-CODE_____________
DELIVERY ADDRESS: _________________________________
ORDER:____________________________________________________________
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CUSTOMER NAME: ____________________________________
PHONE:WK/_____________HM/CELL________________FAX_______________
P/U TIME__________DEL. TIME__________EVENT TIME____
EVENT DATE: _________________________________________
LAMBRUSCO’Z TO GO/1344 E. 41ST STREET, TULSA, OK 74105/496-1246 FAX 496-2199
A minimum delivery charge of $20.00 will be added to the total.
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