12 May Poutineville

Last Name

First Name

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Meal choice

Hat Trick (Fries,curd cheese,bacon,ground beef,hot dogs, house gravy Classic (fries,curd cheese & house gravy Vegetarian (fries,curd cheese,mushrooms,onions,peppers,corn,olives,pepper sauce gravy

Acknowledgementt

Yes

I acknowledge if my meal isn't picked up between 11:30 -12:30 my account will be charged $5.00

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12 May Poutineville

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