FOOTPRINTS' LUNCH ORDER FORM Milpitas
Name of Child:_____________________________; Age of Child:_____________
Room number or Room Color:_________;Class Name:____________________
1.  Write down number of days eating school lunch:_____ X $3.00 per lunch = $_________
2.  Amount charged:___________;  Name of School:_________________________
3.  Amount paid:______________  Cash?_________; Check #_________________
4.  Put a Check mark in the box to indicate you want your child to have lunch that day.
5.  Put an X mark in the box no lunch is needed.
6.  Return this form with a check written out to DAISY HSIEH on the 3rd Friday
prior to the next month so we can order the lunch.  Make one check for the whole month by
writing down your child's name and for which month the check is covered for at the "MEMO
AREA" of the check.			Write VEG. in the boxes  for vegetarian lunches. Thanks!
*Please write down the date in the box so we know which date and
month you are paying for.
For the MONTH of:  FEBRUARY 2009
Monday		Tuesday		Wednesday		Thursday		Friday
2.		3.		4.		5.		6.
9.		10.		11.		12.		13.
16.	CLOSED!	17.		18.		19.		20.
23.		24.		25.		26.		27.
FOR OFFICE USE ONLY:
1.  Amount Charged:_____________: Amt. Rec'd:_____________
2. Paid by Cash?_______;  Check #_______________________
3.  Balance (Cr / Db):_______________;  Logged in book:_________
4. Month covered for:____________; Date received:___________
5. Employee's name who received the payment:________________
6.  Employee's Signature of the receipt:_______________________
mil-lunchorder-022009.excel.c.2.01.09