Fill Out Order Form Below Name * First Name Last Name Email * Phone * (###) ### #### Choose Hookah Head Please Choose One of The Following Options Watermelon Head $60 Pineapple Head $50 Orange Head $45 Regular Head $40 Head Refill HOOKAH MUST BE PURCHASED TO ORDER A REFILL Watermelon Head Refill $30 Pineapple Head Refill $25 Orange Head Refill $25 Regular Head Refill $20 Please Select Hookah Flavor * Bagdadi Strawberry Splash 2 Apple Mi Amoor English Lord Berlin Night Lady Killer Blue Orange Havana Sky Fall Mighty Freeze Prospect Park Mix Creamsicle Sex on The Beach Watermelon Freeze Blue Magic Titanic Peach Moonlight Mist Verry Berry Please Provide Table Number Below * Thank you for your order! A Hookah Staff member will be with you shortly.