One Lunch Order Form Please fill out the form below to order a single lunch for the week of SG DEC 11-14. If you want to order more than one lunch for the week please go back & click on the 2 to 5 Lunches button. Parent Name * Student Name * Phone * Email * Teacher * Class Room * --------------------------------------------- LUNCH DATE Monday Tuesday Wednesday Thursday Friday SPECIALS Daily-Special $6.50 SANDWICHES Ham Cheese $5.50 Egg Salad $5.50 Club $7.50 Roast Beef $5.50 WRAPS & BUNS Pizza Bun $5.50 Chick. Wrap $6.50 EVERYDAY FAVORITES Dry-Boneless-Ribs $7.75 Chicken-Strips $7.75 Pancakes-Syrup $5.00 Hotdog Beef-Chick $3.50 Chicken-Burger $6.00 Perogies-Sour Crm $5.75 Nachos-CheeseDip $5.50 Salsa $1.00 SALADS Chicken-Caesar $8.00 Taco-In-A-Bag $7.50 Potato Salad $4.50 Pasta Salad $4.50 HEALTHY SNACKS Veg Cup (gf) $4.50 Fruit-Cocktail-Cup $1.25 Apple (gf) $1.25 Orange (gf) $1.00 Ched.Cheese $1.50 Hboil-Eggs(gf) $2.00 DRINKS Choc-Milk 500ml $2.25 White-Milk 500ml $2.25 Bottle Water $2.00 Apple Juice $2.00 Orange Juice$2.00 EXTRAS EVERYDAY Hot Rod $1.25 Peach Jello $2.00 Dilly Pickles $3.75 BAKING Rice Krispie $2.25 Carrot Bread $3.00 Brownie(gf) $3.50 Cinn. Bun $3.50 M&M Cookie $1.25 Fruit Muffin $3.00 POTATO CHIPS Ms-Vickis-Reg(gf) $2.00 Ms-Vickis-S&V $2.00 Veggie-Straws(gf) $2.00 Breton-Veg-Bites $1.25 Payment Information Amount $ Convenience fee $ Gross Amount $ Payment Method Paypal Credit Card Number* Expiration Date* 01 02 03 04 05 06 07 08 09 10 11 12 / 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Card (CVV) Code* Card Holder Name*