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) | $4.05 | ____________ | ____________ | ||||||
| Sesame† (680g) | $4.20 | ____________ | ____________ | ||||||
| Millet Flax† (750g) | $4.20 | ____________ | ____________ | ||||||
| Rice Sunflower† (750g) | $4.20 | ____________ | ____________ | ||||||
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| Whole Spelt*† (750g) | $4.55 | ____________ | ____________ | ||||||
| Spelt Sesame*† (750g) | $4.65 | ____________ | ____________ | ||||||
| Spelt Rice*† (750g) | $4.65 | ____________ | ____________ | ||||||
| Spelt Raisin*† (750g) | $4.90 | ____________ | ____________ | ||||||
| Rye Spelt*† (800g) | $3.85 | ____________ | ____________ | ||||||
| Spelt Hemp*† (750g) | $5.15 | ____________ | ____________ | ||||||
| Kamut*† (750g) | $4.50 | ____________ | ____________ | ||||||
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| Rice Loaf**† (750g) | $5.10 | ____________ | ____________ | ||||||
| Raisn Rice Loaf**† (750g) | $5.50 | ____________ | ____________ | ||||||
| Quinoa**† (750g) | $5.55 | ____________ | ____________ | ||||||
| Buckwheat**† (750g) | $5.10 | ____________ | ____________ | ||||||
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| treats | |||||||||
Cinnamon Buns*† (170g each) -individual |
$1.70 $15.05 |
____________ ____________ |
____________ ____________ |
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| Carrot Cake*† (170g) | $2.05 | ____________ | ____________ | ||||||
| Raspberry Squares* (95g) | $1.90 | ____________ | ____________ | ||||||
| Vegan Raspberry Squares*† (95g) | $1.90 | ____________ | ____________ | ||||||
| Blueberry Squares* (95g) | $1.90 | ____________ | ____________ | ||||||
| Pesto Rolls* (95g) | $2.05 | ____________ | ____________ | ||||||
| Turnovers* (110g) | $1.90 | ____________ | ____________ | ||||||
| Vegan Turnovers*† (95g) | $1.90 | ____________ | ____________ | ||||||
| Palm Leaves* (75g) | $1.75 | ____________ | ____________ | ||||||
| Cinnamon Palm Leaves* (70g) | $1.75 | ____________ | ____________ | ||||||
Strudel* -whole |
$8.55 $5.10 |
____________ ____________ |
____________ ____________ |
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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 | |||||||||
| Truffles - Grand Marnier
- Esspresso- Peppermint- Raspberry |
$1.45 each | ____________ |
____________ |
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| Traditional Holiday Fruit Cake (with Brandy)- 1 lb- 2 lb |
$10.65 $18.95 |
____________ ____________ |
____________ ____________ |
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| Fruit Cake (Non alcohol) - 1 lb- 2 lb |
$10.05 $17.55 |
____________ ____________ |
____________ ____________ |
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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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