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 3: September 18 - September 22 - add $25.00
Week 4: September 25 - September 29 - 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