2007 Malibu Lodge Banquet
Banquet Dinner order form
Menu *all meals include one main Burger item, one soda and one bag of chips.
Hamburger meal $5.25 #__________$_________
Cheeseburger meal $5.50 #__________$_________
Double-DoubleŽ meal $6.50 #__________$_________
Grilled cheese meal $5.00 #__________$_________
Lasagna, Salad, Bread, Drink $6.75 #__________$_________
You may order additional burgers:
Hamburger $3.25 #__________$_________
Cheeseburger $3.50 #__________$_________
Double-DoubleŽ $4.50 #__________$_________
Grilled cheese $3.00 #__________$_________
Total Quantity and cost for Meal #__________$_________
Side Salad $2.50 # __________$_________
Total Quantity and cost for Dinner & Show ($3.00 each) #__________$_________
Total Payable for all (Acct. No. 1-6801-070-00) $_________
This order form is due by 5:00 p.m.
on December 18, 2006
at the Anna
Ruggieri Service Center in Van Nuys.
This form may be mailed, dropped off or faxed to 1-818-901-4887.
Name of Person(s) Attending (Print): ___________________________________________________
Phone: __________________ Email: ___________________________________________________
Credit Card (Please Circle): VISA MASTERCHARGE Card Number: ____________________
Name on Card: _________________________________ Expiration Date: __________________
Authorization Signature: _________________________