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DELIVERY ORDER FORM

Please fax completed form to 6887 5796 OR email your order to karen@takopachi.com Visit our website @ www.tori-q.com

Name : Company : Delivery address :

Contact Nos : Date of delivery :

(office) Time of delivery :

(mobile)

YAKITORI STICKS Chicken Pork Chicken Fillet Chicken Skin Chicken Wing Chicken with green pepper Tontoro Pork Chicken Balls Pork with Asparagus Unagi Special request:

per stick $1.00 $1.10 $1.10 $1.10 $1.20 $1.20 $1.20 $1.30 $1.80 $2.00

qty

BENTO SETS Bento A

per set $5.10

qty

(2 chicken, 1 chicken ball & 1 pork)

Bento B

$5.20

(2 chicken, 1 chicken ball & 1 chicken with green pepper)

Bento C
(3 unagi)

$6.70

* kindly write the qty required in the box

~ ~ Note: We will contact you for confirmation upon receving your faxed order ~ ~ For Tori-Q Staff Order received by :

Order date :