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Pizza Delivery Order Form Template
 
Category Pizza Selection Total
Pizza Selection:*  
Toppings (Small):  
Toppings (Medium):  
Toppings (Large):  
Toppings (X-Large):  
Toppings (Party SIze):  

Category Drinks & Extras Quantity Total
Drinks:  
Extras:  
Sub-Total:  
Tax (AZ 8.1%):  
Delivery Charge: ($5.00):  
Grand Total:  
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*  
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:  
Delivery Information
Same as billing info*
Yes  No 
First Name:*  
Middle Initial:  
Last Name:*  
Address Line 1:*  
Address Line 2:*  
City:*  
State:*  
Zip Code:*  
Payment Information
Payment Method:*
Credit Card  Cash on Delivery (C.O.D.) 
Card Number:*   No dashes or spaces please
Expiration Month:*   From your card
Expiration Year:*   From your card
Card Brand:*  
 
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