Contact & Billing Information
First & Last Name:
Street Address:
City:
Postal Code:
Phone:
Email:

Order Information
Delivery or Pick Up?	- Choose an Option - Pickup (no charge) Delivery ($10.00 per delivery - additional fees will apply in surrounding areas)
Delivery Address (If different from Billing Address listed above):
Please provide the name and phone number of an onsite contact (if different from above):
How many meals would you like? ($21.95 each)	- Choose an Option - 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Additional Items
Perogies ($11.95 each - comes with 12 pieces)	- Choose an Option - 1 2 3 4 5 6 7 8 9 10
Cabbage Rolls ($11.95 each - comes with 12 pieces)	- Choose an Option - 1 2 3 4 5 6 7 8 9 10
Mixed Berry Apple Crisp ($4.95 each)	- Choose an Option - 1 2 3 4 5 6 7 8 9 10

Additional Information
Notes:

Please enter your email address to receive a confirmation email: