Fritanta Monimbo Restaurant

Fax Order Form

Enter your address and phone number below.

Name:    
Address: 
City:      Zip: 

            Area     Phone
            Code     Number          Ext.
Telephone:    

We will need to confirm your order at this phone number before we deliver.

  Enter your order with the items and quantities below:

Item 1: Qty:
Rice & Bean or White Rice and Plantains or Tortilla or Plantains & Salad

Item 2: Qty:
Rice & Bean or White Rice and Plantains or Tortilla or Plantains & Salad

Item 3: Qty:
Rice & Bean or White Rice and Plantains or Tortilla or Plantains & Salad

Item 4: Qty:
Rice & Bean or White Rice and Plantains or Tortilla or Plantains & Salad

           Comments:			             Additional Items:	
           

                          Delivery   Pick-up   Card number

Thank you for your order.