Student's Name

Class

- Select Dietary Restrictions - Gluten Free Dairy Free No Beef Vegetarian Other-Please Specify in the box marked "Comments" at Checkout

Week 5: May 30 - add $5.00
Full Month: June 5 - June 30 - add $100.00
Week 1: June 5 - June 9 - add $25.00
Week 2: June 12 - June 16 - add $25.00
Week 3: June 19 - June 23 - add $25.00
Week 4: June 26 - June 30 - add $25.00

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