Click to create your own form using this template   
More
Templates

Select food items, click 'Add to Cart' below to demonstrate features of this cart
          
LOADING...  Please wait.

Home Style Restaurant Takeout Order Form
Pickup
Date & Time of Pickup*
 
Order No

Phone*

Email*

APPETIZERS & SIDES
Onion Rings
 Add to Cart
Mozzarella Sticks
 Add to Cart
Fried Pickle Chips
 Add to Cart
Breaded Mushrooms
 Add to Cart
Sweet Potato Fries
 Add to Cart
Fresh Cut French Fries
 Add to Cart
Tater Tots
 Add to Cart
Baked Potato
 Add to Cart
Loaded Baked Potato
 Add to Cart
Side Dishes
 Add to Cart
Sweet Potato Wedges
 Add to Cart
Nacho Beef Platter
 Add to Cart
STEAKS & SEAFOOD
8 oz. Top Sirloin
 Add to Cart
10 oz. KC Strip
 Add to Cart
14 oz. Ribeye
 Add to Cart
Steak & Shrimp
 Add to Cart
Fried Jumbo Shrimp
 Add to Cart
21 pc. Shrimp Dinner
 Add to Cart
Fresh Chopped Steak
 Add to Cart
BURGERS
Hamburger
 Add to Cart
Cheeseburger
 Add to Cart
Bacon Cheeseburger
 Add to Cart
Mushroom Swiss
 Add to Cart
Patty Melt
 Add to Cart
The Western Burger
 Add to Cart
SANDWICHES
Hand Breaded Tenderloin
 Add to Cart
Grilled Pork Tenderloin
 Add to Cart
Grilled Reuben
 Add to Cart
Hot Ham & Cheese
 Add to Cart
BBQ Pulled Pork
 Add to Cart
Philly Steak Melt
 Add to Cart
Chicken Philly
 Add to Cart
Grilled Chicken Breast
 Add to Cart
Breaded Chicken Breast
 Add to Cart
Chicken Bacon Ranch
 Add to Cart
Country Ham Sandwich
 Add to Cart
Grilled Cheese
 Add to Cart
Classic BLT
 Add to Cart
Club Sandwich
 Add to Cart
Chicken Wrap
 Add to Cart
DINNERS
Chicken Fried Steak
 Add to Cart
2 pc. Chicken Dinner
 Add to Cart
Chicken Tenders
 Add to Cart
Country Ham Dinner
 Add to Cart
Hot Beef Sandwich
 Add to Cart
Chicken Fried Chicken
 Add to Cart
Hot Pork Tenderloin
 Add to Cart
SALADS
Grilled Chicken Salad
 Add to Cart
Breaded Chicken Salad
 Add to Cart
Chef Salad
 Add to Cart
KIDS MENU
2 Chicken Tenders
 Add to Cart
Grilled Cheese
 Add to Cart
5 Mini Corn Dogs
 Add to Cart
2 Garlic Toast Mini Pepperoni Pizzas
 Add to Cart
Peanut Butter & Jelly Sandwich
 Add to Cart
Popcorn Shrimp
 Add to Cart
DESSERTS
Dessert
 Add to Cart
Bowl of Ice Cream
 Add to Cart
DRINKS
Soft Drinks
 Add to Cart
Fresh Brewed Iced Tea
 Add to Cart
Lemonade
 Add to Cart
Coffee
 Add to Cart
Hot Chocolate
 Add to Cart
White Milk
 Add to Cart
Chocolate Milk
 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:*

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:*

Reset Checkout
Powered by Elbowspace.com