New Hampshire Food Bank Phone: 603-669-9725 Purchased Items Order Form Page: 1 Fax: 603-669-0270   Effective: 11/19/07   Date   __________________   Program No.   __________________   Program Name ________________________________________   Ordered By ___________________ Pickup / Delivery Date _________________________ Item No. Item Description Pack Size Unit Weight Fee Order Qty Total Weight PUR001    Tuna Chunk Light In Water   48- 6 oz. Cans   CASE   23   34.35       PUR002 Teddie creamy Peanut Butter 12- 18 oz. CASE 15 17.33   PUR003  Whole Kernel sweet Corn 24- 15.25 oz. CASE 27 11.85   PUR012   Hospitality Instant mashed potatoe flakes   12- 15 oz.   CASE   14   16.25       PUR014 Ground beef 90-10 1 lb packs 12/1lb packs per case CASE 13 31.65   PUR016   Venice Maid Beef Stew   12/15oz.   CASE   13   13.86       PUR018 California Sliced Peaches 24-15 oz cans per case CASE 27 16.80   PUR023 State Fair Grape Jelly 12-18 oz CASE 20 13.60   PUR024   Green Beans Cut   24-14.5oz   CASE   27   13.32       PUR025 Harvest Choice Chicken Noodle Soup 24-10.75oz CASE 19 18.03   PUR026 Farmland all Meat Franks 24-16oz CASE 24 31.44   PUR031   Chicken Stew Dinty Moore   12-15oz cans   CASE   13   20.94       Total Case Weight: _________________ Order Filled By ___________________ X .05 Delivery Fee $ ___________________ Check Amount Received $ ___________________   Calculate your delivery fee by totaling your case weight and multiply it by .05   Check Number ___________________   Product Amount $ ___________________   A check must be presented to the driver for THIS ORDER ONLY upon delivery.   Total Amount Due $ ___________________