Vera's Burger Shack Fax Form INSTRUCTIONS: Please print clearly, print and fax this form to the Vera's Burger Shack nearest you. Fax your order 30 minutes prior to pick-up time.   If we don't call to confirm your order sent by fax or online within 10 minutes, please call us. Prices may vary by location. Subject to change without notice. Contact Information Name:__________________ Phone:_________________ Pickup Time:__________________ Order # 1 What would you like to order? ________________________________________ What Flavour Shots on your item? ________________________________________ Whats Sides would you like ________________________________________ What would you like to drink? ________________________________________ Order # 3 What would you like to order? ________________________________________ What Flavour Shots on your item? ________________________________________ Whats Sides would you like ________________________________________ What would you like to drink? ________________________________________ Order # 5 What would you like to order? ________________________________________ What Flavour Shots on your item? ________________________________________ Whats Sides would you like ________________________________________ What would you like to drink? ________________________________________ Order # 2 What would you like to order? ________________________________________ What Flavour Shots on your item? ________________________________________ Whats Sides would you like ________________________________________ What would you like to drink? ________________________________________ Order # 4 What would you like to order? ________________________________________ What Flavour Shots on your item? ________________________________________ Whats Sides would you like ________________________________________ What would you like to drink? ________________________________________ Order # 6 What would you like to order? ________________________________________ What Flavour Shots on your item? ________________________________________ Whats Sides would you like ________________________________________ What would you like to drink? ________________________________________