All orders can be paid by check (to Food Chain) at the time of delivery, or mailed in advance. We will begin accepting credit cards in February, 2000. We will happily take monthly payments on a subscription. If you would like to do this, please have a check ready for your deposit and one month's meals at the first delivery. We will invoice you monthly for subsequent meals. We will contact new customers to confirm information. * = required information
1. Customer
Your First Name *
Your Last Name *
Email Address*
Daytime Phone*
Evening Phone
If you have ordered with Food Chain before and your delivery and mailing information is the same, you may skip to Delivery Details
2. Delivery Address
Company/ Organization: (if applicable)
Street Address
Cross Streets ("between X and Y" or "corner of X")
Zip
3. Mailing Address (if different from Delivery Address)
Company/ Organization: (if applicable)
Street Address
City
State
Zip
4. Subscription Details
Subscription level* (for pricing, click here)	4 meals ($149) 6 meals ($195) 13 meals ($357) 25 meals ($620) 50 meals ($1095) 80 meals ($1565)
Do you currently have a deposit with Food Chain?	Yes
Delivery frequency*	custom list of delivery dates (mm/dd/yyyy): -or- Regular deliveries every Mon, Wed, Fri (except major holidays) twice weekly M, W M, F W, F weekly M W F every other week M W F monthly 1st 2nd 3rd 4th M W F
# of meals to deliver each time*
Date of first Delivery* (dd/mm/yyyy, numbers only, e.g. 01/15/2000)
Delivery Instructions (e.g. where to leave meal and pick up payment, location of keys, etc.)
Alternate Delivery Instructions (In case we are unable to follow your instructions, please indicate another method of delivery, like a location close by where we can leave your meal.)
How did you hear about Food-Chain?	a friend/coworker saw us on delivery other (please specify)
If a Food Chain customer told you about us, please tell us who so we can thank them.
5. Payment Information
Method*	check at delivery Visa/Mastercard
Card #
Expiry Date (mm/yy)
If you are paying by Credit Card, and ordering 13 meals or more, would you like to spread your payments out over a number of months? Your initial charge will be for $200, and the remainder will be divided among monthly charges.	No, charge me for the total now. Yes, charge me $200 now, and the remainder over the next TWO months. Yes, charge me $200 now and the remainder over the next FOUR months.
6. Service Agreement
"I understand that Food Chain is a small business and that every meal costs Food Chain money and effort to prepare and deliver. If there is a problem with my delivery instructions, for instance no one is there to receive the meal when I said there would be, Food Chain will make a reasonable attempt to leave the food elsewhere, but that if delivery is not possible, I am still responsible for promptly paying for the meal. I also understand that Food Chainwill make all reasonable efforts to notify me if there is a problem delivering my order, and that if I am not satisfied with my meal, I may request a credit or refund." Type your full name to indicate you have read and agree to the Service Agreement:
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