Merriam Lunch and Milk Ticket Order Form

Merriam Lunch and
Milk Ticket Order Form

Revised Dec. 16, 2003.


   Student Name ________________________________________

           Date ____/____/__________
        
        Teacher ________________________________________

A lunch ticket buys a meal that includes milk. A milk ticket buys milk only.

Lunch:

  ____ $10.00 for  5 tickets ____ $20.00 for 10 tickets
  ____ $30.00 for 15 tickets ____ $40.00 for 20 tickets
  ____ $50.00 for 25 tickets ____ $60.00 for 30 tickets

Milk:

  ____ $ 2.00 for  5 tickets ____ $ 4.00 for 10 tickets 
  ____ $ 6.00 for 15 tickets ____ $ 8.00 for 20 tickets 
  ____ $10.00 for 25 tickets ____ $12.00 for 30 tickets

Total amount of check $____________

Please make checks payable to: Acton Public Schools