EzDineInn Inc.
2000 San Pablo Avenue
Berkeley, CA 94704
(510) 644-3331 (W)   (510) 644-3334 (F)
http://www.ezdineinn.com/
Email:inquiry@ezdineinn.com
Please print multiple copies of this form to place your order by fax
Restaurant Name :  
Customer Name :  
Address :  
 
City, State, Zip :  
Order Date/Time :  
Customer's Contact Phone# :  
Item# Food description with preference (include drinks also) Quantity