Fax Order Form

In the K-Mart Shopping Center
528 Donelson Pike
Nashville, TN 37214

Phone: 615-889-9700           Fax: 615-872-9201

Name or Company Name:___________________________________________________________________

Order Submitted By: ____________________________________ Phone:______________________________

Sandwich Bread Cheese Toppings Dressing Ovenbaked,
Steamed		 Chips Drink Side Combo
(Name or #) (Please Specify Where Applicable) or Cold   Item    
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   
                   

Pick Up Time Desired: __________________

Order To Be Picked Up By:______________________________