Duck and Decanter Fax Order Form

Since 1972

DUCK and DECANTER^®FAX ORDER FORM
____ 1651 E Camelback Rd (602) 274-5429 - FAX (602) 274-5672

_{______}3111 N Central Ave (602) 234-3656 - FAX (602) 234-1338

_____One North Central Ave (602) 266-6637 - FAX (602) 253-4351

Due Date: ___________ Due Time: __________ Delivery or Pick Up (circle one)

Company: __________________________________________ Contact: ____________________

Address: __________________________________ City: _______________ Zip _____________

Phone ( ) _____________ FAX ( ) _________________

Payment (circle one): Cash Check AmEx MC Visa Diner's Club Discover Duck Chg

Charge #: __________________________________________ Expiration Date:______________

NAME:_______________________________________________________

SANDWICH/SALAD: __________________________________________

BREAD: FRENCH / ONION / KAISER / LT RYE / DK RYE / MARBLE / SOURDOUGH / PITA / MULTIGRAIN

WITH: MAYO / MUSTARD / LETTUCE / TOMATO / CHEESE

EXTRAS: ____________________________________________________________________

SALAD 4oz or 8oz : _______________________ SOUP 8oz or 16oz: __________________

DRINK: _____________________________________________________________________

MISC: ______________________________________________________________________

SPECIAL INSTRUCTIONS:_____________________________________________________
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