Student's Name

Class

- Select Dietary Restrictions - Gluten Free Dairy Free No Beef Vegetarian

Week 2: April 9 - April 13 - add $25.00
Week 3: April 16 - April 20 - add $25.00
Week 4: April 23 - April 27 - add $25.00
Week 5: April 30 - May 4 - add $25.00

Full Month: May 7th - May 29th - add $80.00
Week 1: May 7th - 11th - add $25.00
Week 2: May 14th - May 18th - add $25.00
Week 3: May 21st - May 25th - add $25.00
Week 4: May 29th - add $5.00

Please enter the dates you would like to order a sandwich (I.E.: 5/5, 5/6, 5/7 . . . )

- Select Payment - Credit Cash - less $125.00 Check - less $125.00