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Asian Restaurant Takeout Order Form
Pickup
Date & Time of Pickup* 
Order No
Email*
Phone*
Chinese Combo
Chicken
Curry Chicken
 Add to Cart
Chicken
Moo Goo Gai Pan
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Chicken
Chicken with Broccoli
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Chicken
Cashew Chicken
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Chicken
General Tao`s Chicken
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Chicken
Orange Chicken
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Chicken
Chicken with Green Beans
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Chicken
Spicy Garlic Chicken
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Chicken
Kung Pao Chicken
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Chicken
Sweet & Sour Chicken
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Chicken
Teriyaki Chicken
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Chicken
Lo Mein (Chicken)
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Pork
Sweet & Sour Pork
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Pork
Spicy Garlic Pork
 Add to Cart
Pork
Lo Mein (Pork)
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Beef
Kung Pao Beef
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Beef
Spicy Shredded Beef
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Beef
Beef with Broccoli
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Beef
Mongolian Beef
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Beef
Kung Pao Beef
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Beef
Lo Mein (Beef)
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Sea Food
Spicy Garlic Shrimp
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Sea Food
Kung Pao Shrimp
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Sea Food
Shrimp or Combination Lo Mein
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Sea Food
Shrimp with Asparagus
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Sea Food
Shrimp with Mixed Vegetables
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Sea Food
Fish Fillet with Mixed Vegetables
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Vegetables
Kung Pao Tofu
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Vegetables
Spicy Garlic Broccoli and Tofu
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Vegetables
Lo Mein (Vegetables)
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Noodle Soup
Japanese Udon Noodle Soup
Chicken, mushroom and napa cabbage
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Chinese House Noodle Soup
Shrimp, chicken, beef and assorted vegetables
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Bento Box
Choice from A to F any Two (2) different items, served with Miso Soup, Salad and Steamed White Rice
Bento Box
A. Sushi (Chef`s choice 6pcs)
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Bento Box
B. Sashimi (Chef`s choice 4pcs)
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Bento Box
C. California Roll
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Bento Box
D. Mixed Tempura
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Bento Box
E. Teriyaki Chicken
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Bento Box
F. Shrimp Tempura Roll
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Roll Special
Choose any two different rolls - (Served with miso soup)
Roll
Avocado Cucumber Roll
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Roll
Vegetable Roll (asparagus, avocado, cucumber and carrot)
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Roll
Sweet Potato Roll
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Roll
Salmon Roll
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Roll
Tuna Roll
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Roll
White Tuna Roll
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Roll
Hamachi Roll
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Roll
Eel Avocado Roll
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Roll
JB Roll (salmon, cream cheese and avocado)
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Roll
California Roll
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Roll
Spicy Tuna Roll
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Roll
Spicy Salmon Roll
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Roll
Spicy Scallop Roll
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Roll
Spider Roll
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Roll
Shrimp Tempura Roll
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Roll
Smoked Salmon Roll
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Roll
Alaska Roll (salmon, avocado, cucumber and topped with masago)
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Roll
Mexican Roll (shrimp tempura, avocado and jalapeno)
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Desserts
Desserts
Ice Cream Choice of vanilla or green tea
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Desserts
Cheese Cake (Slice)
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Desserts
Mochi Ice Cream Choice of green tea, mango or strawberry
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Desserts
Banana Explosion Tempura banana with ice cream
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Beverages
Fountain Drink
Coke (Free Refills)
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Fountain Drink
Diet Coke (Free Refills)
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Fountain Drink
Sprite (Free Refills)
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Fountain Drink
Dr Peper (Free Refills)
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Fountain Drink
Iced Tea (Free Refills)
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Fountain Drink
Lemonade (Free Refills)
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Juice
Apple(No Refills)
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Juice
Orange(No Refills)
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Tea
Hot Tea (Per Person)
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Tea
Thai Iced Tea (No Refill)
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Bottled Water
S. Pellegrino Natural sparkling mineral water 750 ml
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Chardonnay Glass
House
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Chardonnay Glass
Kendall-Jackson Vintner`s Reserve, California
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Chardonnay Bottle
Kendall-Jackson Vintner`s Reserve, California
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Chardonnay Bottle
Wine
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Chardonnay Bottle
DeLoach, Russian River California
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Chardonnay Bottle
Sonoma-Cutrer
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White Zinfandel Glass
House
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Pinot Noir Glass
House
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Pinot Noir Bottle
Cavit, Trento, Italy
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Pinot Noir Bottle
Kenwood, Russian River Valley, California
 Add to Cart
Cabernet Sauvignon Glass
House
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Cabernet Sauvignon Glass
Columbia Crest Grand Estates, Columbia Valley, Washington
 Add to Cart
Cabernet Sauvignon Bottle
Columbia Crest Grand Estates, Columbia Valley, Washington
 Add to Cart
Cabernet Sauvignon Bottle
Rutherford, Napa Valley, California
 Add to Cart
Cabernet Sauvignon Bottle
Beauleu Vineyard, Sonoma,California
 Add to Cart
Cabernet Sauvignon Bottle
Francis Coppola Diamond Collection Claret, California
 Add to Cart
Cabernet Sauvignon Bottle
Jordan, Alexandar Valley, California
 Add to Cart
Beer 12 oz. Bottles
Bud Light
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Beer 12 oz. Bottles
Kirin Light
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Beer 12 oz. Bottles
Heineken
 Add to Cart
Beer 12 oz. Bottles
Kirin
 Add to Cart
Beer 12 oz. Bottles
Sapporo
 Add to Cart
Beer 12 oz. Bottles
Tsing Tao
 Add to Cart
Beer 22 oz. Bottles
Sapporo Tin
 Add to Cart
Beer 22 oz. Bottles
Asahi
 Add to Cart
Billing Information
First Name:*Same name as on your card
Middle Initial:
Last Name:*
Address Line 1:*Where your statement is mailed
Address Line 2:Apt. or Suite No.
City:*
State:*
Zip Code:*
Phone:
Payment Information
Payment Method:*
Credit Card PayPal 
Card Number:*No dashes or spaces please
Expiration Month:*From your card
Expiration Year:*From your card
Card Brand:*
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