Care Package Order Form

Care Package Order Form
Please fill out the form and choose the desired package. You can choose the date intended when the order may be sent, but in no case would it be sent earlier than two days after the order is made.
Name of Recipient
First NameLast Name
Student/Staff ID #
Date of Delivery
MonthDayYear
Date
Delivery Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Please indicate any food allergies of the recipient that you are aware of
Personalized Message
Package
Fruity Package - $25All Night Study Package - $25Sweet Kiss Package (Chocolate Lovers) - $25Happy Birthday Package - $25
Fruity Package
This package includes:
1 Red Apple
1 Green Apple
1 Bottle Lemonade
2 Oranges
All Night Study Package
This package includes:
2 Root Beer
1 Mountain Dew
1 Kettle Chips - Large
1 Peanuts - Large Pack
2 Skittles - Medium
2 Lays - Small
Sweet Kiss Package
This package includes:
2 Root Beer
1 Hershey's Kisses - Plain (small)
1 M&M's - Plain (small)
2 Strawberry Tart
2 Oreo Cookies
2 Snickers Bar
Happy Birthday Package
This package includes:
2 Root Beer
1 Kettle Chips - Large
1 M&M's - Plain
2 Poptarts
2 Skittles
2 Pasta
Total Amount
My Products
prevnext( X )
USDDescription
Sender Information
Your Name
First NameLast Name
Your Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Should be Empty: