+ TheBoatSushiThaiCuisine.com


Please fill out the following information below to complete your order - also sign-up for the B-O-A-T.com "VIP" :
 
Billing Information: Credit Card Information:
   
Name: *
Address:
City:
State:          Zip:
Phone: *
Fax:
Email: *
  
REQUIRED FIELDS *
Name on Credit Card *
we'll bill your *
Credit Card Number 
3 digit code on the back
 
*
* i.e. 123
Exp Date: Month *   Year  

PICK-UP DAY  *     PICK NAME: 
PICK-UP TIME *  Dinner Timer * 

DELIVERY DAY 
DELIVERY TIME  Delivery Dinner
 


Pay secure with www.PayPal.com to our account 310MrINTERNET@gmail.com Michael Scherich CPA, call after paid

VIP Member Information:       (1 minute shopping!)

after SIGN-UP for VIP above  login here
Instruction: The next time, you like to shop with B-O-A-T.com
Just put your "VIP code" in the "VIP field" and you'll shop 100% secure,
without putting any personal information on the Internet.
Comments/Special Instructions: (for preparation, delivery) PLEASE CHOOSE
YOUR SPICY STYLE
 
LINK 2 CHILE HEAT SCALE

 *  CLICK   PLEASE PRINT FOR YOUR RECORD

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