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First name
*
Last name
*
Email
Phone
*
Number of Chicken Meals Requested $30
*
Number of Bifana Meals Requested $30
*
Number of Malasada's Requested $3
*
Number of Rice Pudding's Requested $3
*
Pick Up Time
*
12:00pm-12:30pm
12:30pm - 1:00pm
1:00pm-1:30pm
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