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Billing Information:	Credit Card Information:
Name: * Address: City: State:          Zip: Phone: * Fax: Email: *    REQUIRED FIELDS *	Name on Credit Card * we'll bill your * Visa....... Master Card Credit Card Number  3 digit code on the back  * * i.e. 123 Exp Date: Month * 01 02 03 04 05 06 07 08 09 10 11 12   Year   2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 PICK-UP DAY  * Today MON TUE WEN THU FRI SAT SUN     PICK NAME:  PICK-UP TIME *  LUNCH 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45   Dinner Timer *  DINNER 6:00 6:15 6:30 6:45 7:00 7:15 7:30 7:45 8:00 8:15 8:30 8:45 9:00 9:15 9:30 DELIVERY DAY  Today MON TUE WEN THU FRI SAT SUN DELIVERY TIME LUNCH 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45    Delivery Dinner  DINNER 6:00 6:15 6:30 6:45 7:00 7:15 7:30 7:45 8:00 8:15 8:30 8:45 9:00 9:15 9:30