TLC Delivered
Printable Order Form
**This form must be printed out and mailed via the postal service**

Send To:
University Dining Shops & Services
Millersville University
P.O. Box 1002
Millersville, PA 17551-0302

or Phone:
(717) 871-5692

or Fax:
(717) 871-2412



Check Item Cost Qty. Subtotal
• Welcome to M.U. $20.00 _________ _________
• Trick or Treat $25.00 _________ _________
• Exam Cram $25.00 _________ _________
• Valentine's Day $25.00 _________ _________
• Get Well Package $15.00 _________ _________
• Healthy Snacking $25.00 _________ _________
• 21st Birthday Package $20.00 _________ _________
 
• Cookie Club Each Month $10.00
Whole year $50.00 		_________ _________
Check desired month(s): • October • November • December
• February • March • April   •All
• Birthday Cake Special $20.00 _________ _________
Check desired cake flavor: • Vanilla • Chocolate • Marble
• Pizza Party $20.00 _________ _________
Check desired topping: • Cheese • Pepperoni
Subtotal _________
If order is for 4 or more packages Less 15% _________
Total Enclosed _________

Student Information

Name: ____________________________________ Phone: _______________________________
Address: ____________________________________________________________________________

Purchaser Information

Name: ____________________________________ Phone: _______________________________
Address: ____________________________________________________________________________

For Visa®, Mastercard® and Discover® Card Customers

Card Number: ____________________________________________ Exp.: ___________________

• Visa®

 • Discover® • Mastercard®

Fax: (717) 871-2412
Signature: _______________________________________________ Date: ___________________
Make Checks Payable to: Millersville University
Send Check or Money Order to: Shops & Services
Millersville University
P.O. Box 1002
Millersville, PA 17551-0302
Delivery Date(s) _____________________________________________________________________

Card Messages

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