Boxed Lunch Order Form

Volunteer

Community Living Brant

May 19, 2012

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-COMMUNITY LIVING BRANT- Complaints Regarding Services Procedure You will find Community Living Brant’s complete Complaints Policy and Procedures Self-Advocacy section listed on main menu above.

BOX LUNCH ORDER FORM CHOICE OF SANDWICH: 1 PER LUNCH ORDERED Box lunch includes: Bottled Water, Fresh Fruit, Veggies, Dessert
		X Moose's Club
		X Moose's Veggie
		Total # of lunches ordered for this location
		Total Amount Due ($10.00 x total # of lunches)
Name of Organization / Business

Contact Person - First + Last		Email Address

Address - No. + Street

Phone#	Fax #
Check one:
Pick up at Moose Winooski's restaurant between 11am-12pm Directions to be forwarded with your confirmation
Deliver to above address between 11am-12pm Must have a minimum of 10 orders per location for delivery
Check one payment method: If paying by credit card, please call 519-756-2662 to process your payment.
Cash Cheque Visa Master Card
Security Code: