Fill-Out Form Example for Ordering Pizza

Type in your street address:

Type in your phone number:

Which toppings would you like?

  1. Pepperoni.
  2. Sausage.
  3. Anchovies.
How would you like to pay? Choose any one of the following:

  1. Cash.
  2. Check.
  3. Credit card:
    • Mastercard.
    • Visa.
    • American Express.
Would you like the driver to call before leaving the store?

Yes.
No.
To order your pizza, press this button: .