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Your Name: *
Your Apartment: *
Your Telephone #: *
Your Email Address: (leave blank if none)
PURCHASE WITH YOUR DINING POINTS: Select the quantity of each item you'd like.
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loaf SLICED WHEAT BREAD (8pts)
dozen MUFFINS (8pts)
dozen COOKIES (8pts)
6 cans CRANBERRY JUICE (8pts)
6 cans V8 JUICE (8pts)
bottle CHARDONNAY (15pts)
bottle MERLOT (15pts)
bottle CHAMPAGNE (15pts)
4 servings CHEERIOS (6pts)
4 servings RAISIN BRAN (6pts)
1 cup FRUIT YOGURT (3pts)
1 pint STRAWBERRY ICE CREAM (8pts)
1/2 dozen EGGS (8pts)
pint VANILLA ICE CREAM (8pts)
pint CHOCOLATE ICE CREAM (8pts)
15-pack TISSUES (3pts)
2 sheets FABRIC SOFTENER (3pts)
6 loads LAUNDRY DETERGENT (3pts)
6 loads DISH DETERGENT (3pts)
1 mini DISHWASHING LIQUID (3pts)
50 13-gal COMPOST. TRASH BAGS (20pts)
1lb DRY SPAGHETTI (6pts)
deck PLAYING CARDS (6pts)
large FRESH FRUIT CUP (10pts)
small FRESH FRUIT CUP (6pts)
2-pack KOTEX ULTRA THIN (0pts)
mini TOOTHPASTE (3pts)
1oz HAND LOTION (3pts)
disposable FACE MASK (2pts)
1 roll TOILET PAPER (2pts)
CHARGES ADDED TO YOUR MONTHLY STATEMENT: Select the quantity of each item you'd like.
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1/2 gallon ORANGE JUICE ($5)
1/2 gallon GRAPEFRUIT JUICE ($5)
1/2 gallon LEMONADE ($4)
1/2 gallon SOYMILK ($5)
6-pack SNAPPLE Iced Tea ($8)
6-pack DIET SNAPPLE Iced Tea ($8)
33.8oz TEJAVA Black Tea ($3)
1 box BRAN FLAKES ($4)
1 jar PASTA SAUCE ($4)
SHAVING CREAM ($4)
1 roll PAPER TOWELS ($3)
1 bottle HAND SANITIZER GEL ($8)
1/2 gallon WHOLE MILK ($4)
1/2 gallon 2% MILK ($4)
1/2 gallon SKIM MILK ($4)
Would you like to request any ADDITIONAL ITEMS?  (charges will be added to your monthly billing statement, based upon availability.)
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