Customer Information:
Name:
Address:
Phone:
Date:	Time:
	Selct Delivery Time 11:30am 12:00am 12:30am 1:00pm 1:30pm 2:00pm 2:30pm 3:00pm 3:30pm 4:00pm 4:30pm 5:00pm 5:30pm 6:00pm 6:30pm 7:00pm 7:30pm 8:00pm 8:30pm 9:00pm 9:30pm 10:00pm 10:30pm 11:00pm 11:30pm
Type of Pizza:
Cheese Pizza	Veggie Pizza
Meat Pizza
Custom Pizza:
Pineapples	Olives
Pepperoni	Bell Peppers
Payment:
Cash	Credit
Card Number:
CVV
Expiration Date:(MM/YY)
Postal Code: