LAbite.com | FAX ORDER FORM

		FAX ORDER FORM
		FAX: 310-446-5512
		TEL: 310-441-BITE (2483)
Date and Time: __________________________
Your Name:______________________________	Company Name: ___________________
Address:_________________________________	Nearest Cross Street: ______________
Telephone: _____________________________	Fax Number: ______________________
Payment Method (please circle one): Cash. Company Check . VISA . MC . AMEX . DINER'S CLUB

RESTAURANT NAME:
ITEM NUMBER	ITEM NAME	QUANTITY	REMARKS
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Beverages Available:	Pepsi, Diet Pepsi, Lemonade and Aquafina Bottled Water
.	Individual 12oz. Cans $1.50. Assorted Beverages $1.50 each (min 6)
SPECIAL ORDERING INSTRUCTIONS:
SPECIAL ORDERING INSTRUCTIONS:
Upon a receipt of your fax, we will call you to confirm your order. If you do not hear from us, please call or re-fax your order with the words "second request." Thank you.