LaFollette Square 1Breakfast Sack Meal Form

Dining - LaFollette Square 1Breakfast Sack Meal Form

eOrder Form for a Sack Meal

Breakfast Meal Equivalency = $4.00 (Fall and Spring 2009-2010) If items ordered exceed this amount, overage can be paid with Dining Plus, Cardinal Ca$h, or when sack meal is picked up with cash, personal check, or credit card.

Items with an * indicate a required field.

Date needed *
Time of day you will pick up /pay for your meal? *
First Name *
Middle Initial *
Last Name *
Address Line 1 *
Address Line 2
Phone *
Email *
Fruit and Juice	Mixed Fruit Cup $.99 Apple, Whole $.50 Orange,Whole $.50 Banana, Whole $.50 Very Fine Apple Juice $1.79 Very Fine Orange Juice $1.79 Very Fine Cranberry Juice $1.79
Bread and Cereal	Otis Spunkmeyer Muffin Banana Nut $1.25 Otis Spunkmeyer Muffin Blueberry $1.25 Kelloggs Apple Jacks $1.29 Kelloggs Special K $1.29 Kelloggs Frosted Flakes $1.29 Slice of White Bread $.15 Slice of White Bread $.15 Slice of Wheat Bread $.15 Slice of Wheat Bread $.15 Poptart 2 pkg, Cinnamon $.95 Poptart 2 pkg, Chocolate Fudge $.95 Poptart 2 pkg, Strawberry $.95
Eggs and Dairy	Eggs, Hard Boiled 2 for $.60 Milk, 2% 1 pint $1.09 Milk, skim 1 pint $1.09 Milk, Chocolate 1 pint $1.09
Beverages	Evian $1.50 Coke 20 oz $1.30 Diet Coke 20 oz $1.30 Sprite 20 oz $1.30 Mountain Dew 20 oz $1.30 Diet Mountain Dew 20 oz $1.30
Condiments	Margarine $.10 Margarine $.10 Jelly $.15 Jelly $.15 Peanut Butter 2 oz $.50 Peanut Butter 2 oz $.50
If meal exceeds $4.00, overage on....?	Dining Plus Cardinal Cash Cash (payable at pick up) Personal Check (payable at pick up) Credit Card - Visa or MasterCard (payable at pick up)
Comments and Special Instructions

Substitutions may be made if the dining unit is 'out of stock' for an item you have requested.