Little Stream u.S. Order Form |
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NAME ______________________________________________________________________ ADDRESS ___________________________________________________________________ APT # ______________________________________________________________________ CITY _______________________________________________________________________ STATE _____________________________________________________________________ ZIP ________________________________________________________________________ COUNTRY ___________________________________________________________________ |
WORK PHONE #___________________________ HOME PHONE # ___________________________ SOCIAL SECURITY #________________________ |
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| Bread and treats | Price | Quantity | Total | ||||||
| Bread | |||||||||
| Whole Wheat† (680g) | $3.90 | ____________ | ____________ | ||||||
| Sesame† (680g) | $4.05 | ____________ | ____________ | ||||||
| Millet Flax† (750g) | $4.05 | ____________ | ____________ | ||||||
| Rice Sunflower† (750g) | $4.05 | ____________ | ____________ | ||||||
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| Whole Spelt*† (750g) | $4.35 | ____________ | ____________ | ||||||
| Spelt Sesame*† (750g) | $4.45 | ____________ | ____________ | ||||||
| Spelt Rice*† (750g) | $4.45 | ____________ | ____________ | ||||||
| Spelt Raisin*† (750g) | $4.70 | ____________ | ____________ | ||||||
| Rye Spelt*† (800g) | $4.65 | ____________ | ____________ | ||||||
| Spelt Hemp*† (750g) | $4.95 | ____________ | ____________ | ||||||
| Kamut*† (750g) | $4.35 | ____________ | ____________ | ||||||
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| Rice Loaf**† (750g) | $4.85 | ____________ | ____________ | ||||||
| Raisn Rice Loaf**† (750g) | $5.20 | ____________ | ____________ | ||||||
| Quinoa**† (750g) | $5.40 | ____________ | ____________ | ||||||
| Buckwheat**† (750g) | $4.70 | ____________ | ____________ | ||||||
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| treats | |||||||||
Cinnamon Buns*† (170g each) -individual |
$1.65 $13.95 |
____________ ____________ |
____________ ____________ |
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| Carrot Cake*† (170g) | $1.85 | ____________ | ____________ | ||||||
| Raspberry Squares* (95g) | $1.85 | ____________ | ____________ | ||||||
| Vegan Raspberry Squares*† (95g) | $1.85 | ____________ | ____________ | ||||||
| Blueberry Squares* (95g) | $1.85 | ____________ | ____________ | ||||||
| Pesto Rolls* (95g) | $2.00 | ____________ | ____________ | ||||||
| Turnovers* (110g) | $1.85 | ____________ | ____________ | ||||||
| Vegan Turnovers*† (95g) | $1.85 | ____________ | ____________ | ||||||
| Palm Leaves* (75g) | $1.70 | ____________ | ____________ | ||||||
| Cinnamon Palm Leaves* (70g) | $1.70 | ____________ | ____________ | ||||||
Strudel* -whole |
$7.95 $4.80 |
____________ ____________ |
____________ ____________ |
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| Cool Hemp Energy Cookies*†- chocolate
(60g)- raisin (60g) |
$1.35 $1.35 |
____________ ____________ ____________ |
____________ ____________ ____________ |
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Double chocolate cookies, gluten free**† (60g) |
$1.30 | ____________ | ____________ | |
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| Special Seasonal Items | |||||||||
| Traditional Holiday Fruit Cake (with Brandy)- 1 lb- 2 lb |
$9.90 $17.55 |
____________ ____________ |
____________ ____________ |
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| Fruit Cake (Non alcohol) - 1 lb- 2 lb |
$9.35 $16.25 |
____________ ____________ |
____________ ____________ |
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| .10¢ discount for bulk items and unsliced bread |
____________ |
____________ | |||||||
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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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