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* Indicates required question
Email
*
Your email
Name of Restaurant
*
Your answer
Town
*
Your answer
Phone Number
*
use the format: (XXX) XXX-XXXX
Your answer
Link to Mother's Day Special on Website or Specific Social Media Post
*
Don't forget to use http://
Your answer
Orders Must Submitted By (Date)
*
MM
/
DD
/
YYYY
Owner/Management First Name
*
for Boozy Burbs use only
Your answer
Owner/Management Last Name
*
for Boozy Burbs use only
Your answer
Availability
*
Curbside pickup
Delivery made by our own staff/personnel
Required
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