Please fill in all selections / toppings for each order.
Burrito Tortillas: Flour, Wheat, Spinach, Jalapeno Cheese, Chipotle -- Mini Burrito / Quesdilla Tortillas: Flour or Wheat
NAME: ____________________________
Item Selection
○
BURRITO: Surchero / Mini / Kids
Tortilla_________________________________
○
BURRITO BOWL
○
QUESADILLA: Loaded / Cheese
Mini / Light / Kids
Tortilla_________________________________
○
NACHOS: Loaded / Mini / Kids
○
TACOS: Hard or Soft / Kids
○
SALAD: Shell or No Shell
Meat Selection
○
Chicken
○
Steak
○
Ground Beef
○
Vegetarian
Toppings
○
Rice
○
Beans: Black or Pinto
○
Shredded Cheese
○
Lettuce: Iceberg or Romaine
○
Surcheros Sauce
○
Sweet & Sour
○
Southwest Vinaigrette
○
GRILL THE VEGGIES
○
Spinach
○
Pico de Gallo
○
Banana Peppers
○
Bell Peppers
○
Jalepeños: Fresh or Pickled
○
Cilantro
○
Onions: Green or Red or Yellow
○
Mushrooms
○
Black Olives
○
Tomatoes
○
Cucumbers
○
Squeezed Lime
○
Sour Cream
○
Guacamole
○
Corn Salsa
Dressings: Ranch, Lite Ranch, Lite Italian,
Lite Thousand Island
White Cheese Dip
○
Small
○
Medium
○
Large
Drink
Kids ___________________________________
Regular________________________________
Large __________________________________
○
Delicious Smores Quesadilla? $4.29
○
Oreo Cookies 69¢
Other _________________________________
Taco orders come with 2 tacos. If you would like each taco dierent, please fill out a fax form for each taco.
Kids Entrees come with Meat Selection and 3 Toppings, steak 99¢ extra. Kids entrees with more than 3 toppings will be considered a mini.
NOTICE: PLEASE CALL US TO VERIFY YOUR ORDER HAS BEEN RECEIVED.
FAX ORDER FORM
NAME: ____________________________
Item Selection
○
BURRITO: Surchero / Mini / Kids
Tortilla_________________________________
○
BURRITO BOWL
○
QUESADILLA: Loaded / Cheese
Mini / Light / Kids
Tortilla_________________________________
○
NACHOS: Loaded / Mini / Kids
○
TACOS: Hard or Soft / Kids
○
SALAD: Shell or No Shell
Meat Selection
○
Chicken
○
Steak
○
Ground Beef
○
Vegetarian
Toppings
○
Rice
○
Beans: Black or Pinto
○
Shredded Cheese
○
Lettuce: Iceberg or Romaine
○
Surcheros Sauce
○
Sweet & Sour
○
Southwest Vinaigrette
○
GRILL THE VEGGIES
○
Spinach
○
Pico de Gallo
○
Banana Peppers
○
Bell Peppers
○
Jalepeños: Fresh or Pickled
○
Cilantro
○
Onions: Green or Red or Yellow
○
Mushrooms
○
Black Olives
○
Tomatoes
○
Cucumbers
○
Squeezed Lime
○
Sour Cream
○
Guacamole
○
Corn Salsa
Dressings: Ranch, Lite Ranch, Lite Italian,
Lite Thousand Island
White Cheese Dip
○
Small
○
Medium
○
Large
Drink
Kids ___________________________________
Regular________________________________
Large __________________________________
○
Delicious Smores Quesadilla? $4.29
○
Oreo Cookies 69¢
Other _________________________________
NAME: ____________________________
Item Selection
○
BURRITO: Surchero / Mini / Kids
Tortilla_________________________________
○
BURRITO BOWL
○
QUESADILLA: Loaded / Cheese
Mini / Light / Kids
Tortilla_________________________________
○
NACHOS: Loaded / Mini / Kids
○
TACOS: Hard or Soft / Kids
○
SALAD: Shell or No Shell
Meat Selection
○
Chicken
○
Steak
○
Ground Beef
○
Vegetarian
Toppings
○
Rice
○
Beans: Black or Pinto
○
Shredded Cheese
○
Lettuce: Iceberg or Romaine
○
Surcheros Sauce
○
Sweet & Sour
○
Southwest Vinaigrette
○
GRILL THE VEGGIES
○
Spinach
○
Pico de Gallo
○
Banana Peppers
○
Bell Peppers
○
Jalepeños: Fresh or Pickled
○
Cilantro
○
Onions: Green or Red or Yellow
○
Mushrooms
○
Black Olives
○
Tomatoes
○
Cucumbers
○
Squeezed Lime
○
Sour Cream
○
Guacamole
○
Corn Salsa
Dressings: Ranch, Lite Ranch, Lite Italian,
Lite Thousand Island
White Cheese Dip
○
Small
○
Medium
○
Large
Drink
Kids ___________________________________
Regular________________________________
Large __________________________________
○
Delicious Smores Quesadilla? $4.29
○
Oreo Cookies 69¢
Other _________________________________
NAME: ____________________________
Item Selection
○
BURRITO: Surchero / Mini / Kids
Tortilla_________________________________
○
BURRITO BOWL
○
QUESADILLA: Loaded / Cheese
Mini / Light / Kids
Tortilla_________________________________
○
NACHOS: Loaded / Mini / Kids
○
TACOS: Hard or Soft / Kids
○
SALAD: Shell or No Shell
Meat Selection
○
Chicken
○
Steak
○
Ground Beef
○
Vegetarian
Toppings
○
Rice
○
Beans: Black or Pinto
○
Shredded Cheese
○
Lettuce: Iceberg or Romaine
○
Surcheros Sauce
○
Sweet & Sour
○
Southwest Vinaigrette
○
GRILL THE VEGGIES
○
Spinach
○
Pico de Gallo
○
Banana Peppers
○
Bell Peppers
○
Jalepeños: Fresh or Pickled
○
Cilantro
○
Onions: Green or Red or Yellow
○
Mushrooms
○
Black Olives
○
Tomatoes
○
Cucumbers
○
Squeezed Lime
○
Sour Cream
○
Guacamole
○
Corn Salsa
Dressings: Ranch, Lite Ranch, Lite Italian,
Lite Thousand Island
White Cheese Dip
○
Small
○
Medium
○
Large
Drink
Kids ___________________________________
Regular________________________________
Large __________________________________
○
Delicious Smores Quesadilla? $4.29
○
Oreo Cookies 69¢
Other _________________________________
SEE WWW.SURCHEROS.COM FOR
FAX NUMBERS FOR EACH LOCATION.
