FAX ORDER FORM

(Please call to confirm your order. Allow 30 minutes for preparation. For lunch orders, please fax by 10:30 a.m.)

ITEM DESCRIPTIONSALSA

(Burrito/Salad/Taco) (Chicken/Pork/Steak/Veggie)BEANS and RICE EXTRA CHARGE ITEMS

SIDESBlack Pinto Rice Sour Créme Guacamole Fajita Veg

Day/Date: ________________________________________ Company Name: ____________________________________

Contact Name: ____________________________________ Pick-up Time: _______________________________________

Phone: __________________________________________ Email Address: _____________________________________

Pico de Roasted Chipotle Chipotle Habañero SpecialtyGallo Chile Corn Tomatillo Habañero Garlic & Lime (changes(mild) (mild) (medium) (hot) (super hot) bi-weekly)

Example Burrito Chicken ✓ ✓ Chips & Salsa

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319.277.8228