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	Takeout - Chabad CHAi - South Tampa
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padding-left: 95px;
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color: #235cad;
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color:#fae8b8;
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letter-spacing: 1px;
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float: none !important;
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p{
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<form class="userform-form" action="" method="post" name="form_3290754" id="3290754" accept-charset="utf-8"><input type="hidden" name="formID" value="3290754" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li id="cid_1" class="form-input-wide"> <div class="form-header-group"><h2 id="header_1" class="form-header">Online Order Form</h2><div id="subHeader_1" class="form-subHeader">Simply select your choices for take-out and your freshly prepared, homemade cooked, gourmet meal will ready for pickup or delivery!</div></div> </li><li class="form-line" id="id_84"><div id="cid_84" class="form-input-wide"> <div id="text_84" class="form-html"><div style="text-align: center;"><span style="font-size: 18px;"><span style="font-size: 20px;">For Corporate Clients including Hotels and Restaurants, and custom orders, please </span><a href="/Article.asp?AID=3294592"><span style="font-size: 20px;">contact</span></a><span style="font-size: 20px;"> us directly to place your orders.</span></span></div></div> </div></li><li id="cid_3" class="form-input-wide"> <div class="form-header-group"><h3 id="header_3" class="form-header">Contact Info</h3></div> </li><li class="form-line" id="id_4"><div class="form-label-left" id="label_4"><label for="input_4"> Full Name </label><label class="label-message" for="input_4"> </label></div><div id="cid_4" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q4_fullName[first]" id="first_4" autocomplete="given-name" />  <label class="form-sub-label" for="first_4" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q4_fullName[last]" id="last_4" autocomplete="family-name" />  <label class="form-sub-label" for="last_4" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> E-mail </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <input type="email" class=" form-textbox validate[Email]" id="input_5" name="q5_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Phone Number </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q7_phoneNumber[area]" id="input_7_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_7_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q7_phoneNumber[phone]" id="input_7_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_7_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li id="cid_8" class="form-input-wide"> <div class="form-header-group"><h3 id="header_8" class="form-header">Order Info</h3></div> </li><li class="form-line" id="id_9"><div class="form-label-left" id="label_9"><label for="input_9"> Select a Choice: </label><label class="label-message" for="input_9"> </label></div><div id="cid_9" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_0" name="q9_selectA" value="Delivery" /><label id="label_input_9_0" for="input_9_0"><span>Delivery</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_9_1" name="q9_selectA" value="Pick Up" /><label id="label_input_9_1" for="input_9_1"><span>Pick Up</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_10"><div class="form-label-left" id="label_10"><label for="input_10"> Date </label><label class="label-message" for="input_10"> </label></div><div id="cid_10" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select class="form-dropdown" name="q10_date[month]" id="input_10_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_10_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select class="form-dropdown" name="q10_date[day]" id="input_10_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_10_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select class="form-dropdown" name="q10_date[year]" id="input_10_year"><option></option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option></select>  <label class="form-sub-label" for="input_10_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_11"><div class="form-label-left" id="label_11"><label for="input_11"> Time </label><label class="label-message" for="input_11"> </label></div><div id="cid_11" class="form-input"> <span class="dir_ltr inline_block"><span class="form-sub-label-container"><select class="noDefault form-dropdown" id="input_11_hourSelect" name="q11_time[hourSelect]"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option></select>  <label class="form-sub-label" for="input_11_hourSelect" id="sublabel_hour">Hour</label></span><span class="form-sub-label-container"><select class="form-dropdown" id="input_11_minuteSelect" name="q11_time[minuteSelect]"><option></option><option value="00">00</option><option value="10">10</option><option value="20">20</option><option value="30">30</option><option value="40">40</option><option value="50">50</option></select>  <label class="form-sub-label" for="input_11_minuteSelect" id="sublabel_minutes">Minutes</label></span><span class="form-sub-label-container"><select class="form-dropdown" id="input_11_ampm" name="q11_time[ampm]"><option></option><option selected="selected" value="AM">AM</option><option value="PM">PM</option></select>  <label class="form-sub-label" for="input_11_ampm"><span> </span></label></span></span> </div></li><li class="form-line" id="id_12"><div class="form-label-left" id="label_12"><label for="input_12"> Location Name:  </label><label class="label-message" for="input_12"> </label></div><div id="cid_12" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_12" name="q12_locationName" size="20" value="" /> </div></li><li class="form-line" id="id_13"><div class="form-label-left" id="label_13"><label for="input_13"> Address </label><label class="label-message" for="input_13"> </label></div><div id="cid_13" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q13_address[addr_line1]" id="input_13_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_13_addr_line1" id="sublabel_13_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q13_address[addr_line2]" id="input_13_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_13_addr_line2" id="sublabel_13_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q13_address[city]" id="input_13_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_13_city" id="sublabel_13_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q13_address[state]" id="input_13_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_13_state" id="sublabel_13_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q13_address[postal]" id="input_13_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_13_postal" id="sublabel_13_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q13_address[country]" id="input_13_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_13_country" id="sublabel_13_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_14"><div class="form-label-left" id="label_14"><label for="input_14"> Delivery Fee:  </label><label class="label-message" for="input_14"> </label></div><div id="cid_14" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_14_0" name="q14_deliveryFee" value="South Tampa $18" /><label id="label_input_14_0" for="input_14_0"><span>South Tampa $18</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_14_1" name="q14_deliveryFee" value="Rocky Point $25" /><label id="label_input_14_1" for="input_14_1"><span>Rocky Point $25</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_14_2" name="q14_deliveryFee" value="North Tampa $25" /><label id="label_input_14_2" for="input_14_2"><span>North Tampa $25</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_14_3" name="q14_deliveryFee" value="East Tampa $30" /><label id="label_input_14_3" for="input_14_3"><span>East Tampa $30</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_14_4" name="q14_deliveryFee" value="St. Petersburg $35" /><label id="label_input_14_4" for="input_14_4"><span>St. Petersburg $35</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_14_5" name="q14_deliveryFee" value="The Beaches $50" /><label id="label_input_14_5" for="input_14_5"><span>The Beaches $50</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_15"><div class="form-label-left" id="label_15"><label for="input_15"> Double Wrap:  </label><label class="label-message" for="input_15"> </label></div><div id="cid_15" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_0" name="q15_doubleWrap" value="Standard" /><label id="label_input_15_0" for="input_15_0"><span>Standard</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_1" name="q15_doubleWrap" value="Hotel Oven" /><label id="label_input_15_1" for="input_15_1"><span>Hotel Oven</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_15_2" name="q15_doubleWrap" value="Microwave" /><label id="label_input_15_2" for="input_15_2"><span>Microwave</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_16"><div class="form-label-left" id="label_16"><label for="input_16"> Rush Fee $25 </label><label class="label-message" for="input_16"> </label></div><div id="cid_16" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_16_0" name="q16_rushFee[]" value="Orders made less then 24 hours before pickup/delivery" /><label id="label_input_16_0" for="input_16_0"><span>Orders made less then 24 hours before pickup/delivery</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_74" class="form-input-wide"> <div class="form-header-group"><h2 id="header_74" class="form-header">Sandwiches:</h2></div> </li><li class="form-line" id="id_18"><div class="form-label-left" id="label_18"><label for="input_18"> Tuna Sandwich $6.75 </label><label class="label-message" for="input_18"> </label></div><div id="cid_18" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_18" name="q18_tunaSandwich" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Egg Sandwich $6.75 </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_19" name="q19_eggSandwich" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_20"><div class="form-label-left" id="label_20"><label for="input_20"> Lox and Cream Cheese Sandwich $8.75 </label><label class="label-message" for="input_20"> </label></div><div id="cid_20" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_20" name="q20_loxAnd" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_23"><div class="form-label-left" id="label_23"><label for="input_23"> Turkey Sandwich $9.95 </label><label class="label-message" for="input_23"> </label></div><div id="cid_23" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_23" name="q23_turkeySandwich" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_24"><div class="form-label-left" id="label_24"><label for="input_24"> Pastrami Sandwich $10.95 </label><label class="label-message" for="input_24"> </label></div><div id="cid_24" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_24" name="q24_pastramiSandwich" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_76" class="form-input-wide"> <div class="form-header-group"><h2 id="header_76" class="form-header">Salads:</h2></div> </li><li class="form-line" id="id_26"><div class="form-label-left" id="label_26"><label for="input_26"> Greek Salad $10.00 </label><label class="label-message" for="input_26"> </label></div><div id="cid_26" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_26" name="q26_greekSalad" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_27"><div class="form-label-left" id="label_27"><label for="input_27"> Fresh Salad $9.00 </label><label class="label-message" for="input_27"> </label></div><div id="cid_27" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_27" name="q27_freshSalad" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_28"><div class="form-label-left" id="label_28"><label for="input_28"> Caesar Salad $9.00 </label><label class="label-message" for="input_28"> </label></div><div id="cid_28" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_28" name="q28_caesarSalad" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_78" class="form-input-wide"> <div class="form-header-group"><h2 id="header_78" class="form-header">Soup:</h2></div> </li><li class="form-line" id="id_45"><div class="form-label-left" id="label_45"><label for="input_45"> Chicken Soup with Matzoh Ball $5.75 </label><label class="label-message" for="input_45"> </label></div><div id="cid_45" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_45" name="q45_chickenSoup" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_80" class="form-input-wide"> <div class="form-header-group"><h2 id="header_80" class="form-header">Dessert:</h2></div> </li><li class="form-line" id="id_60"><div class="form-label-left" id="label_60"><label for="input_60"> Fresh Seasonal Fruit $6.50 </label><label class="label-message" for="input_60"> </label></div><div id="cid_60" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_60" name="q60_freshSeasonal" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_61"><div class="form-label-left" id="label_61"><label for="input_61"> Pastry $5.00 </label><label class="label-message" for="input_61"> </label></div><div id="cid_61" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_61" name="q61_cookieCombo" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li id="cid_81" class="form-input-wide"> <div class="form-header-group"><h2 id="header_81" class="form-header">Shabbat Menu:</h2></div> </li><li class="form-line" id="id_63"><div class="form-label-left" id="label_63"><label for="input_63"> Grape Juice (22 oz) $5.25 </label><label class="label-message" for="input_63"> </label></div><div id="cid_63" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_63" name="q63_grapeJuice" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_64"><div class="form-label-left" id="label_64"><label for="input_64"> Challah Roll $2.00 </label><label class="label-message" for="input_64"> </label></div><div id="cid_64" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_64" name="q64_challahRoll" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_65"><div class="form-label-left" id="label_65"><label for="input_65"> Medium Challah $7.50 </label><label class="label-message" for="input_65"> </label></div><div id="cid_65" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_65" name="q65_mediumChallah" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_66"><div class="form-label-left" id="label_66"><label for="input_66"> Gefilte Fish $2.25 (Per Serving) </label><label class="label-message" for="input_66"> </label></div><div id="cid_66" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_66" name="q66_gefilteFish" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_82"><div class="form-label-left" id="label_82"><label for="input_82"> Chicken Entree (served with starch and vegetable) $25.00 </label><label class="label-message" for="input_82"> </label></div><div id="cid_82" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_82" name="q82_gefilteFish82" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_83"><div class="form-label-left" id="label_83"><label for="input_83"> Fish Entree  (served with starch and vegetable) $25.00 </label><label class="label-message" for="input_83"> </label></div><div id="cid_83" class="form-input"> <input type="number" class="form-number-input  form-textbox" id="input_83" name="q83_gefilteFish83" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_67"><div class="form-label-left" id="label_67"><label for="input_67"> Total </label></div><div id="cid_67" class="form-input"> <div id="total_amount">$0.00 </div> </div></li><li class="form-line" id="id_68"><div class="form-label-left" id="label_68"><label for="input_68"> Payment </label><label class="label-message" for="input_68"> </label></div><div id="cid_68" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"></td></tr><tr class="credit_card "><th colspan="2">Credit Card</th></tr><tr class="credit_card "><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express, Discover</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div><div class="cc-icon discover-icon"></div></div><input type="hidden" name="q68_payment[cc_type]" id="input_68_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" 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class="form-textbox validate[visible]" name="q68_payment[cc_exp_month]" id="input_68_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_68_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q68_payment[cc_exp_year]" id="input_68_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2023">2023</option><option value="2024">2024</option><option 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