FormDownload Logo

Free Chipotle State & Madison Fax Order Form - PDF Form Download

Chipotle State & Madison Fax Order Form Overall rating: ☆☆☆☆☆ 0 based on 0 reviews
5 1

Download this Fax Order form for Chipotle State & Madison in PDF Format.

Chipotle State & Madison Fax Order Form


Text Version of this Form

Fax Order Form – State & Madison

(PLEASE FILL OUT COMPLETELY EVEN IF YOU’VE FILLED OUT THE OTHER SIDE)
8 E. Madison 1 START HERE DATE COMPANY NAME CONTACT NAME PHONE PICK-UP TIME? PAGE OF
(PLEASE PRINT) D
Mon–Fri 10:30am-10pm
Sat-Sun 11am-8pm 2 Complete the form below. 3 Fax your order to (312)-629-4766. 4 Call (312)-629-3662 to confirm.

BURRITOS, TACOS & SALADS

BURRITOS & BOWLS ORDER BEANS WITH +$1.95
cilantro-lime rice, vegetarian black beans or RICE cIRcLE oNE SALSA DAIRY N/c oN DRINK
pinto beans (cooked with bacon), meat, salsa, NAME burrito • burrito boWL FAJITA VEG ITEMS PLEaSE WritE iN FLaVor
and cheese or sour cream. Served in a flour cRISPy TAcoS • SofT fLoUR TAcoS WHitE broWN BLAcK PINTo VEG CHk cAR STEAK BAR VEG MiLd MEd MEd Hot SoUR cR CHEESE GUAcAMoLE LETTUcE aNd SPEC iFY SiZE
SoFt CorN taCoS • SaLad ToM coRN GREEN
tortilla or in a bowl.

TACOS
1 W BR B P F C CA S B V M MC MG H SC C G L
Three crispy corn, soft corn or soft flour tortillas
with meat, salsa, sour cream or cheese, and lettuce.

SALADS 2 W BR B P F C CA S B V M MC MG H SC C G L
chopped romaine lettuce with choice of beans,
meat, salsa and cheese. Served with freshly
made chipotle-honey vinaigrette.
3 W BR B P F C CA S B V M MC MG H SC C G L

CHICKEN . . . . . . . . . . . . . . . . . . . . . . . . . . . $6.55
Marinated in our chipotle
adobo, then grilled. 4 W BR B P F C CA S B V M MC MG H SC C G L

STEAK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $6.95
Marinated in our chipotle
adobo, then grilled. 5 W BR B P F C CA S B V M MC MG H SC C G L

CARNITAS. . . . . . . . . . . . . . . . . . . . . . . . . . $6.95
Seared pork, braised for
hours, then shredded. 6 W BR B P F C CA S B V M MC MG H SC C G L

BARBACOA . . . . . . . . . . . . . . . . . . . . . . . . $6.95
Beef braised for
hours, then shredded. 7 W BR B P F C CA S B V M MC MG H SC C G L

VEGETARIAN . . . . . . . . . . . . . . . . . . . . . . $6.55
A vegetarian option with our freshly made
guacamole and vegetarian black beans. 8 W BR B P F C CA S B V M MC MG H SC C G L

SALSAS
Fresh Tomato . . . . . . . . . . . . . . . . . . . . . . . . Mild 9 W BR B P F C CA S B V M MC MG H SC C G L
Roasted Chili-Corn . . . . . . . . . . . . . . . Medium
Tomatillo-Green Chili . . . . . . . . . Medium Hot
Tomatillo-Red Chili . . . . . . . . . . . . . . . . . . . Hot
10 W BR B P F C CA S B V M MC MG H SC C G L

EXTRAS
Chips & Guacamole. . . . . . . . . . . . . . . . . . . . . . .$3.15
Chips & Salsa. . . . . . . . . . . . . . . . . . . . . . . . . . . . .$2.05 11 W BR B P F C CA S B V M MC MG H SC C G L
Guacamole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$1.95

$
Chips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.25

12 W BR B P F C CA S B V M MC MG H SC C G L
DRINKS
$ $
Bottled Drinks. . . . . . . . . . . . . . . . . . 2.10 / 2.50
$ $ O
Soda. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1.60 / 1.90
Example Burrito W BR B P F C CA S B V M MC MG H SC C G L Lg Coke

Chipotle State & Madison Fax Order Form Reviews

Review this Form

Name
Email
Rating
Review