In-N-Out Burger 4×4 or Quad Quad has four 100% American beef patties, hand-leafed lettuce, tomato, spread, four slices of American cheese, with or without onions, stacked high on a freshly baked bun 4. Grilled Cheese Two slices of melted American cheese hand-leafed lettuce, tomato, spread, with or without onions on a freshly baked bun.