THANKSGIVING PIE ORDER FORM *SUBMIT YOUR ORDER BY 3 PM ON TUESDAY, NOVEMBER 24, TO ENSURE PICK-UP ON WEDNESDAY, NOVEMBER 25.* Please note we are closed on Thanksgiving Day and Black Friday. No pie pick-ups will be possible on Thursday, November 26 and Friday, November 27. PRICE SIZE (EACH) QTY 8” $42 PUMPKIN PIE Serves 6-8 ______8” $42 PECAN PIE Serves 6-8 ______8” FAIRHILL FARMS PINK LADY APPLE PIE $42 Serves 6-8 ______SARI SARI STORE FAMOUS BUKO PIE 8” $42 young coconut pastry cream, streusel Serves 6-8 ______8” $60 BASQUE CHEESECAKE Serves 6-8 ______8” $8 VANILLA WHIPPED CREAM Serves 6-8 ______
‘BAKING AT REPUBLIQUE’ COOKBOOK $30 ______
EMAIL ORDERS TO [email protected] | PIE PICK UPS AT REPUBLIQUE REQUIRED *Payment will be processed at the time of order. All sales are final. PAYMENT INFORMATION CARD TYPE: ___ VISA ___ AMEX ___ MASTERCARD
NAME (as it appears on card): ______
BILLING ADDRESS: ______
CARD NUMBER: ______
EXPIRATION DATE: ______SECURITY CODE: ______BILLING ZIP: ______
CONTACT TELEPHONE: ______CONTACT EMAIL: ______
SIGNATURE: ______
I, the above signed, certify that all the information is complete and accurate. I hereby authorize Republique, LLC to collect payment for all the charges indicated herein, including sales tax, by processing a charge to the credit card listed above. I certify that I am the authorized signer of the credit card listed above. A 4% charge will be added to your check to help cover the cost of health care benefits we offer to our full-time employees. Thank you for supporting our staff. If you would like this 4% charge removed, please let us know. By signing above, I understand that payment will be processed at the time of order and that all sales are final. The order will be available for pick up only at Republique on date listed below. Signatory agrees to fully inspect bakery items at time of pick up. Republique is not responsible for any damage that occurs outside the restaurant's premises, e.g. during transport.
PICK-UP INFORMATION FOR PICK-UP AT REPUBLIQUE, 624 SOUTH LA BREA, LOS ANGELES PICK-UP DATE: ______PICK-UP NAME (if different from payment name): ______PICK-UP TIME: ______INTERNAL USE ONLY Other orders in addition to this one: