DATE COMPANY NAME CONTACT NAME PHONE PICK-UP TIME? PAGE OF START HERE (PLEASE PRINT) 1 2 Complete the form below. 3 Fax your order to (843)-836-2444 . 4 Call (843)-836-2442 to confrm. Bluffton Fax Order Form – (PLEASE FILL OUT COMPLETELY EVEN IF YOU’VE FILLED OUT THE OTHER SIDE) 1250 Fording Island Road Suite A 11 am – 10 pm NAME ORDER BURRITO • BURRITO BOWL CRISPY TACOS • SOFT FLOUR TACOS SOFT CORN TACOS • SALAD RICE BEANS FAJITA VEG WITH CIRCLE ONE SALSA DAIRY + $ 1.95 N/C ON VEG ITEMS DRINK PLEASE WRITE IN FLAVOR AND SPECIFY SIZE WHITE BROWN BLACK PINTO CHK CAR STEAK BAR SOFRITAS VEG MILD TOM MED CORN MED GREEN HOT SOUR CR CHEE SE GU AC AMOLE LE TTUCE 1 WBR B P F C CA S B SO V MMC MG H SC C G L 2 WBR B P F C CA S B SO V MMC MG H SC C G L 3 WBR B P F C CA S B SO V MMC MG H SC C G L 4 WBR B P F C CA S B SO V MMC MG H SC C G L 5 WBR B P F C CA S B SO V MMC MG H SC C G L 6 WBR B P F C CA S B SO V MMC MG H SC C G L 7 WBR B P F C CA S B SO V MMC MG H SC C G L 8 WBR B P F C CA S B SO V MMC MG H SC C G L 9 WBR B P F C CA S B SO V MMC MG H SC C G L 10 WBR B P F C CA S B SO V MMC MG H SC C G L 11 WBR B P F C CA S B SO V MMC MG H SC C G L 12 WBR B P F C CA S B SO V MMC MG H SC C G L Ex am pl e Bu rr it o WBR B P F C CA S B SO V MMC MG H SC C G L Lg Coke BURRITOS, TACOS & SALADS BURRITOS & BOWLS Cilantro-lime rice, black or pinto beans, meat, salsa, and cheese or sour cream. Served in a flour tortilla or in a bowl. TACOS Three crispy corn, soft corn or soft flour tortillas with meat, salsa, sour cream or cheese, and lettuce. SALADS Chopped romaine lettuce with choice of beans, meat, salsa and cheese. Served with freshly made chipotle- honey vinaigrette. CHICKEN ................... $ 6.50 Marinated in our chipotle adobo, then grilled. STEAK ......... ... ... ... ... . $ 7.20 Marinated in our chipotle adobo, then grilled. CARNITAS... .. .. ............ $ 6.95 Seared pork, braised for hours, then shredded. BARBACOA.... .. ............ $ 7.20 Beef braised for hours, then shredded. SOFRIT AS . .. .. .. .. .. ....... $ 6.50 Shredded organic tofu braised with chipotle chilis, roasted poblanos and a blend of aromatic spices. VEGGIE .... ... ... .......... $ 6.50 A vegetarian option with our freshly made guacamole and black beans. SALSAS Fresh Tomato.... .... ........... .... .Mild Roasted Chili-Corn... ... ... ... ... M edium Tomatillo-Green Chili .. .. .. .. . Me di um Hot Tomatillo-Red Chili........ .... .... ... Hot EXTRAS Chips & Gu ac amole.. .. .. .. .. . .. .. $ 3.25 Chips & S alsa... .. .. .. .. .. .. ...... $ 1.95 Guacamole . . . . . . . . . . . . . . . . . . . . . . . $ 1.95 Chips .......... ..... ..... ..... ... $ 1.30 DRINKS Bottled Drin ks. .. .. .. .. . .. $ 2.25 / $ 2.60 Soda..... ..... ............ $ 1.80 / $ 2.10

Chipotle Mexican Grill order form

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A faxable order form uploaded Dec. 12, 2014. See http://order.chipotle.com for the most up-to-date order forms for your nearest location.

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DATE COMPANY NAME CONTACT NAME PHONE PICK-UP TIME? PAGE OFSTART HERE (PLEASE PRINT) D1

2 Complete the form below. 3 Fax your order to (843)-836-2444. 4 Call (843)-836-2442 to confirm.

Bluffton Fax Order Form (PLEASE FILL OUT COMPLETELY EVEN IF YOUVE FILLED OUT THE OTHER SIDE)

1250 Fording Island Road Suite A

11 am 10 pm

NAME

ORDERBURRITO BURRITO BOWL

CRISPY TACOS SOFT FLOUR TACOS SOFT CORN TACOS SALAD

RICE BEANSFAJITA

VEG

WITHCIRCLE ONE

SALSA DAIRY+$1.95N/C ON

VEG ITEMSDRINK

PLEASE WRITE IN FLAVOR AND SPECIFY SIZEWHITE BROWN BLACK PINTO CHK CAR STEAK BAR SOFRITAS VEG

MILDTOM

MEDCORN

MED GREEN

HOT SOUR CR CHEESE GUACAMOLE LETTUCE

1 W BR B P F C CA S B SO V M MC MG H SC C G L

2 W BR B P F C CA S B SO V M MC MG H SC C G L

3 W BR B P F C CA S B SO V M MC MG H SC C G L

4 W BR B P F C CA S B SO V M MC MG H SC C G L

5 W BR B P F C CA S B SO V M MC MG H SC C G L

6 W BR B P F C CA S B SO V M MC MG H SC C G L

7 W BR B P F C CA S B SO V M MC MG H SC C G L

8 W BR B P F C CA S B SO V M MC MG H SC C G L

9 W BR B P F C CA S B SO V M MC MG H SC C G L

10 W BR B P F C CA S B SO V M MC MG H SC C G L

11 W BR B P F C CA S B SO V M MC MG H SC C G L

12 W BR B P F C CA S B SO V M MC MG H SC C G L

Example Burrito W BR B P F C CA S B SO V M MC MG H SC C G L Lg Coke

BURRITOS, TACOS & SALADS

BURRITOS & BOWLSCilantro-lime rice, black or pinto beans, meat, salsa, and cheese or sour cream. Served in a flour tortilla or in a bowl.

TACOSThree crispy corn, soft corn or soft flour tortillas with meat, salsa, sour cream or cheese, and lettuce.

SALADSChopped romaine lettuce with choice of beans, meat, salsa and cheese. Served with freshly made chipotle-honey vinaigrette.

CHICKEN. . . . . . . . . . . . . . . . . . . $6.50 Marinated in our chipotle adobo, then grilled.

STEAK . . . . . . . . . . . . . . . . . . . . . .$7.20 Marinated in our chipotle adobo, then grilled.

CARNITAS. . . . . . . . . . . . . . . . . . .$6.95 Seared pork, braised for hours, then shredded.

BARBACOA. . . . . . . . . . . . . . . . . .$7.20 Beef braised for hours, then shredded.

SOFRITAS . . . . . . . . . . . . . . . . . . $6.50 Shredded organic tofu braised with chipotle chilis, roasted poblanos and a blend of aromatic spices. VEGGIE . . . . . . . . . . . . . . . . . . . . $6.50 A vegetarian option with our freshly made guacamole and black beans.

SALSASFresh Tomato . . . . . . . . . . . . . . . . . . . . . . . . Mild Roasted Chili-Corn . . . . . . . . . . . . . . . MediumTomatillo-Green Chili . . . . . . . . . Medium HotTomatillo-Red Chili . . . . . . . . . . . . . . . . . . . Hot

EXTRASChips & Guacamole. . . . . . . . . . . . . . . $3.25Chips & Salsa. . . . . . . . . . . . . . . . . . . . .$1.95Guacamole . . . . . . . . . . . . . . . . . . . . . . . $1.95Chips . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1.30

DRINKSBottled Drinks . . . . . . . . . . . . $2.25 / $2.60Soda. . . . . . . . . . . . . . . . . . . . . . $1.80 / $2.10

O