Billing Information
First & Last Name:
Street Address:
City:
Phone:
Email:
Company Name:

Guest Contact Information
Guest(s) First and Last Name
Guest Cell Phone Number
Guest Email

Order Information
Number of Guests	- Choose an Option - 1 2 3 4 5 6 7 8 9 10
Delivery or Pick Up?	- Choose an Option - Delivery in Edmonton and surrounding area (between 11:30am-4:30pm) (No Additional Charge) Pick up (between 11:30am-4:30pm)
Delivery Location (If different from Billing Information above):

Choose Your Menu Quantities - Starters $19.75
Charcuterie Box	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10
Vegetarian Antipasto Box	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10

Choose Your Menu Quantities - Entrée $27.45
South Asia Butter Chicken	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10
Alberta Roast Beef	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10
Mediterranean Stuffed Peppers	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10

Choose Your Menu Quantities - Dessert $7.65
French Macarons	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10
Canadian Cupcake	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10
Continental Chocolate Mousse (gluten free)	- Choose an Option - 0 1 2 3 4 5 6 7 8 9 10

Choose Your Menu Quantities - Beverages
Red Wine (Gray Monk Pinot Noir) $30	- Choose an Option - 0 1 2
White Wine (Gray Monk Pinot Grigio) $30	- Choose an Option - 0 1 2
Non-Alcoholic Sparkling Wine $20	- Choose an Option - 0 1 2

Additional Information:

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