Picnic Order Form
CALL YOUR ORDER IN AT 540-446-2266
OR
PRINT AND FAX IN TO 540-658-9939
Number of people:
1
2
3
4
Food selection:
Cheese- Market Price
o
Grafton Village four year
cheddar
o
Laura chenel goat cheese
with herbs
o
Baby gouda
o
Brillat Savarin- triple
cream brie
Sandwiches/wraps- $4.50 each
o
Mango chutney chicken salad
on croissant
o
Roast beef with blue cheese
mayo, lettuce, tomato on ciabatta
o
Vegetarian wrap with
grilled veggies, tapenade and garlic mayo
o
Chicken Cesar wrap
Salads- $2.50 each
o
Red skin potato salad with
green beans and pesto mayo
o
Traditional coleslaw
o
Mediterranean pasta salad
Hummus & pita- 4.50 each
Fruit-
$1.00 each
o
Pear
o
Apple
o
Orange
Baguette- $4.00
Brownie- $2.00 each
Biscotti- $2.00 each
Flatware, plates, napkins, basket- $4.00 (required fee)
Other specifications:
____________________________________________________________
____________________________________________________________
Customer Information:
Name:________________________________________
Number:______________________________________
Date & pick-up time:____________________________
Credit Card number:____________________________
Expiration date:________________________________
Billing Zip Code:________________________________
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