Little Stream Order Form |
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NAME ______________________________________________________________________ ADDRESS ___________________________________________________________________ APT # ______________________________________________________________________ CITY _______________________________________________________________________ PROVINCE __________________________________________________________________ POSTAL CODE_______________________________________________________________ COUNTRY ___________________________________________________________________ |
WORK PHONE #___________________________ HOME PHONE # ___________________________ SOCIAL SECURITY #________________________ |
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| Bread and treats | Price | Quantity | Total | |||||||||
| Bread | ||||||||||||
| Whole Wheat† (680g) | $4.00 | ____________ | ____________ | |||||||||
| Sesame† (680g) | $4.25 | ____________ | ____________ | |||||||||
| Millet Flax† (750g) | $4.25 | ____________ | ____________ | |||||||||
| Rice Sunflower† (750g) | $4.25 | ____________ | ____________ | |||||||||
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| Whole Spelt*† (750g) | $4.65 | ____________ | ____________ | |||||||||
| Spelt Sesame*† (750g) | $4.80 | ____________ | ____________ | |||||||||
| Spelt Rice*† (750g) | $4.80 | ____________ | ____________ | |||||||||
| Spelt Raisin*† (750g) | $5.05 | ____________ | ____________ | |||||||||
| Rye Spelt*† (800g) | $4.45 | ____________ | ____________ | |||||||||
| Spelt Hemp*† (750g) | $5.25 | ____________ | ____________ | |||||||||
| Kamut*† (750g) | $4.65 | ____________ | ____________ | |||||||||
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| Rice Loaf**† (750g) | $5.15 | ____________ | ____________ | |||||||||
| Raisn Rice Loaf**† (750g) | $5.50 | ____________ | ____________ | |||||||||
| Quinoa**† (750g) | $5.75 | ____________ | ____________ | |||||||||
| Buckwheat**† (750g) | $4.80 | ____________ | ____________ | |||||||||
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| treats | ||||||||||||
Cinnamon Buns*† (170g each) -individual |
$1.80 $14.85 |
____________ ____________ |
____________ ____________ |
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| Carrot Cake*† (170g) | $2.20 | ____________ | ____________ | |||||||||
| Raspberry Squares* (95g) | $2.10 | ____________ | ____________ | |||||||||
| Vegan Raspberry Squares*† (95g) | $2.10 | ____________ | ____________ | |||||||||
| Blueberry Squares* (95g) | $2.10 | ____________ | ____________ | |||||||||
| Pesto Rolls* (95g) | $2.20 | ____________ | ____________ | |||||||||
| Turnovers* (110g) | $2.10 | ____________ | ____________ | |||||||||
| Vegan Turnovers*† (95g) | $2.10 | ____________ | ____________ | |||||||||
| Palm Leaves* (75g) | $1.90 | ____________ | ____________ | |||||||||
| Cinnamon Palm Leaves* (70g) | $1.90 | ____________ | ____________ | |||||||||
Strudel* -whole |
$9.45 $5.40 |
____________ ____________ |
____________ ____________ |
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| Cool Hemp Energy Cookies*†- chocolate
chip (60g)- raisin (60g) |
$1.55 $1.45 |
____________ ____________ ____________ |
____________ ____________ ____________ |
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Double chocolate cookies, gluten free**† (60g) |
$1.45 | ____________ | ____________ | |
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| Special Seasonal Items | ||||||||||||
| Truffles - Grand Marnier
- Esspresso- Peppermint- Raspberry |
$1.70 each | ____________ |
____________ |
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| Traditional Holiday Fruit Cake (with Brandy)- 1 lb- 2 lb |
$11.45 $20.40 |
____________ ____________ |
____________ ____________ |
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| Fruit Cake (Non alcohol) - 1 lb- 2 lb |
$10.25 $17.75 |
____________ ____________ |
____________ ____________ |
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| .10¢ discount for bulk items and unsliced bread |
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____________ |
____________ | |||||||||
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* wheat alternative, ** gluten free, † vegan |
SUBTOTAL | ____________ | ||||||||||
| First time order (prepay or Visa) | ||||||||||||
| Extra Shipping (if applicable) | SHIPPING | ____________ | ||||||||||
| TOTAL | ____________ | |||||||||||
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