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Kosher Take Out Order Form

Full Name*
First Name Last Name
Shabbat Candles $2 Set of 2
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Bottle of Kosher Wine $11 Per bottle
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Medium Challah $6 Each
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6 small Challah Rolls $12 per 6
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Chicken soup with Matzah Ball $5 per small container
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Gefilta Fish $2.25 for 2 slices
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Babaganoush Eggplant $6.50 small container
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Tuna Salad $6 small container
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Egg Salad $6 small container
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Fresh Veggie Salad $9 small container
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Salmon Entree $25 (served with starch and vegetable)
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Chicken Entree $25 (served with starch and vegetable)
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Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number
Delivery

Takeout
E-mail
Special Instructions
Total

$0.00 USD
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Payment

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