Event Reservation Form

Contact Information

Title

First Name

*

Last Name

*

Address

*

City

*

State

*

Zip

*

Email

*

Selection of products

(M=Meat, D=Dairy, W=Wine, *NEW)

Item Description - amount per package.	Quantities	Price	Total ($25 minimum)
(M) Beef For Stew - 2 lbs		15.00
(M) Ground Beef - 2 lbs		14.00
(M) Chicken Legs - 4 legs		12.00
Gefilte Fish - 20 oz roll		7.00
(D) Cream Cheese - 8oz		4.00
(D) Muenster Cheese - 6 oz		3.00
(D) Lowfat Milk - 1/2 gal		2.50
(D) Whole Milk - 1/2 Gal		2.50
(D) Vanilla Greek Yogurt - 6 oz		1.50
Kedem Grape Juice - 64 oz		6.50
(W) Jeunesse Cabernet - Semi-Sweet Red		10.00
(W) Cabernet Sauvignon - Dry Red		11.00
*Liquid Oil E-Z Lights 44ct		12.00
(Bug-Free) Frozen Broccoli - 24oz		5.00
Total ($25 minimum)

Notes/Comments

Payment Information

Order Total

*

(Optional) Donation Amount

Total Amount

*

Card Number

*

Card Expiration

*

*

Security Code

*

Same as above

Name on Card

*

Billing Address

*

Zip Code

*