Ciro's Product Order Form

Please print and fill out the following order form:

Name:_________________________________________________________________

Address:______________________________________________________________

City:___________________________ State__________ Zip Code_____________

Country:________________________

E-Mail:_________________________

Phone:__________________________

Fax:____________________________


Please enter product and quantity

PRODUCT _____________________________        QUANTITY _____________

PRODUCT _____________________________        QUANTITY _____________

PRODUCT _____________________________        QUANTITY _____________

PRODUCT _____________________________        QUANTITY _____________

PRODUCT _____________________________        QUANTITY _____________



Payment Options

___ I have enclosed a check

___ I have enclosed a money order

___ Please charge my credit card (Fax Orders to: 713-467-9126)


Credit Card Type: _____________		Credit Card Number:_____________________________ 

Expirations Date:_____________


Signature__________________________________    Date___________________


If you have any questions, please send them to ciro@ciros.com

Make checks payable and send entire ordering information to:
        
        Ciro's Italian Grill
	9755 Katy Freeway @ I - 10
	Houston, TX  77055

	713-467-9336
	Fax:  713-467-9126