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School Lunch and Daycare  Payment Form

:: Student's Information:                                       * Required
Student's First Name:*:
Student's Middle Name::
Student's Last Name*:  
Student's School:*:  

:: Bill Payer's Information:
First Name:*:
Last Name*:
Address*:
City*:
State*:
ZIP:*:
Phone Number :   xxx-xxx-xxxx
Email Address*:  
 
Daycare:   + $ 5.00 Convenience Fee if ordered by itself
School Lunch:   + $ 2.50 Convenience fee if ordered by itself.
Payment Amount*: $    
 
= Total:  $   
Includes a Convenience Fee of $ 7.50
Includes a Convenience Fee of $ 5.00
Comments:

:: To finish your order, choose a payment method & click on the button below:

Payment by Check Payment by Credit Card