Palmer Order Form 
Order for Tuesday, May 11
Pick up at Brew HaHa - 1030 S. Colony Way (same bldg as Optimum Performance Chiro)
11:00 am - 1pm 
(Put orders in before 8 pm the night before)
Name on the Order
Enter Custom Fillings in Box Below Choose up to 5
Phone Number:
Credit Card Number:
CVC Code:
Expiry Month:
Expiry Year:
Item amount
Dynamically Updated $XX.00

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