The Custard Company Pie Order Form
Full Name
First Name
Last Name
E-mail
*
example@example.com
Contact Number
*
Pickup Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Pickup Location
*
Dearborn (2801 Monroe Street, Dearborn, Michigan 48124)
Dearborn Heights (23845 W Warren St, Dearborn Heights, MI 48127)
Canton (44296 Cherry Hill Rd, Canton, MI 48187)
Grosse Pointe (15229 Kercheval Ave, Grosse Pointe, MI 48230)
My Products
*
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( X )
Fruity Pebbles Pie
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Oreo Pie
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Reese’s Pie
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Cookie Monster Pie
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Cookie Dough Pie
$
25.00
Quantity
1
2
3
4
5
6
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9
10
Strawberry Shortcake Pie
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Biscoff Pie
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Ashta Pistachio Pie
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Dubai Chocolate Pie
$
35.00
Quantity
1
2
3
4
5
6
7
8
9
10
Special Instructions
Submit Order
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