ChickTilla Pre-Order Form
Please fill out your details and preferences to reserve your order.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Facebook Profile Link
Preferred Claiming Method
*
Pick-up
Deliver to classroom/office
Preferred Payment Method
*
Cash
GCash
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ChickTilla Rolls
Enter description
55.00 PHP
55.00
PHP
Quantity
1
2
3
4
5
6
7
8
9
10
Plain
With Ketchup
Item subtotal:
0.00 PHP
0.00
PHP
Bliss Mayo Dip
10.00 PHP
10.00
PHP
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
0.00 PHP
0.00
PHP
Smokey Cheese Dip
10.00 PHP
10.00
PHP
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
0.00 PHP
0.00
PHP
Quenchy Watermelon
35.00 PHP
35.00
PHP
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
0.00 PHP
0.00
PHP
Quenchy Lychee
35.00 PHP
35.00
PHP
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
0.00 PHP
0.00
PHP
Grab & Go Combo
85.00 PHP
85.00
PHP
Quantity
1
2
3
4
5
6
7
8
9
10
Dip Flavor
Bliss Mayo
Smokey Cheese
Drink Flavor
Quenchy Watermelon
Quenchy Lychee
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For Gcash Payment
Browse Files
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Upload your proof of payment here
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Where would you like us to deliver your order? (For those who chose delivery method)
Please input your building name and room number (e.g., Mother Rita Barcelo Building, MR 222)
Your preferred delivery time (you may choose more than one)
8:30 AM
9:00 AM
10:30 AM
12:00 PM
2:30 PM
Other
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