Carry Out & DeliveryShip to:Name:______________________________________________________________________________Company Name: _____________________________________________ Residential CommercialAddress: __________________________________________________________ Apt/Suite: _________City: ___________________________________ State: __________________ Zip: ________________Email: ______________________________________________________________________________Phone: (Cell) ________-________-____________ (Home) ________-________-____________ Bill to: (If different than SHIP TO address above) Tracking # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Name:______________________________________________________________________________Company Name: _____________________________________________________________________Address: __________________________________________________________ Apt/Suite: _________City: ___________________________________ State: __________________ Zip: ________________Email: ______________________________________________________________________________Phone: (Cell) ________-________-____________ (Home) ________-________-____________

Form must be completed in full for orders to be processed.Items: 8 oz Jumbo Lump Crab Cake $14.99 x __________ = Subtotal $ ______________ 1 Dozen Crab Balls (2 oz ea.) $47.00 x __________ = Subtotal $ ______________Minimum $40.00 per order to ship. In MD, add 6% sales tax $ ______________If you require a signature for drop off, add, $3.00 (UPS Charge) $ ______________If not Shipping or using your own UPS or Fed Ex account, add $8 for packaging materials $ ______________

UPS Shipping & Handling $ ______________

Discount (adds, promo’s) List where from or why $ ____________(Shipping cost is based on UPS rates for Next Day delivery) TOTAL: $ ____________

METHOD OF PAYMENT: (Check one) Visa Master Card Discover Amex. DATE TO BE SHIPPED: _______________ (A MUST)Credit card Number: ____________________________________ Exp. Date: _____________ CCV# _________(If using your UPS or Fed EX #) ____________________________ MUST HAVE CVV 3 or 4 digits on back of Master, Visa, Discover or Amex.

Name: (as it appears on card): ________________________________ Zip code if different ___________

How did you hear about us? ____________________________________________________All Crab Cakes are fresh (uncooked) and shipped overnight with UPS (Prices subject to change without notice)(We ship Monday through Thursday) Please make sure the address is correct and legible. Any address corrections by UPS may cause extra charge of $15 to your account and may delay the shipment.

Crab Cake Order form in house 061112

165 Main St Annapolis, MD 21401 Ph: 410-269-6737 Fax: 410-268-1098

Website: www.chickandRuths.com

Gift Message:____________________________________________________________________________________