Coffee & Tea Order Form
Full Name
*
First Name
Last Name
Contact Number
*
E-mail
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Order Date & Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Please select all your orders below.
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The Mill Blend
12 oz bag of The Mill Blend
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground
1
2
3
4
5
6
7
8
9
10
Good Life Blend
12oz bag of Good Life Blend
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground
1
2
3
4
5
6
7
8
9
10
Dark Italian Roast
12 oz bag of Dark Italian Roast
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground
1
2
3
4
5
6
7
8
9
10
Snickerdoodle
12oz bag of Snickerdoodle
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground
1
2
3
4
5
6
7
8
9
10
Nebraska Blend
12oz bag of Nebraska Blend Coffee
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground
1
2
3
4
5
6
7
8
9
10
Hazelnut
12oz bag of Hazelnut
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground
1
2
3
4
5
6
7
8
9
10
Decaf Mill Blend
12oz bag of Decaf Mill Blend
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground
1
2
3
4
5
6
7
8
9
10
Cold Brew Blend
12oz bag of Cold Brew Blend
$
15.00
Whole Bean or Ground
Quantity
Whole Bean
1
2
3
4
5
6
7
8
9
10
Ground for Toddy
1
2
3
4
5
6
7
8
9
10
English Breakfast Tea
3oz tea tube - loose leaf tea
$
16.00
Quantity
0
1
2
3
4
5
6
7
8
9
10
Heyo Flamingo (Green Gateau)
3oz tea tube - loose leaf tea
$
16.00
Quantity
0
1
2
3
4
5
6
7
8
9
10
Blue Eyes
3oz tea tube - loose leaf tea
$
16.00
Quantity
0
1
2
3
4
5
6
7
8
9
10
Semi-Sweet Hot Cocoa Powder
6oz of Cocoa Powder
$
15.00
Quantity
0
1
2
3
4
5
6
7
8
9
10
The Mill Cider Spices
6oz bag of Cider Spices
$
15.00
Quantity
0
1
2
3
4
5
6
7
8
9
10
White Hot Cocoa Powder
6oz of White Cocoa Mix
$
15.00
Quantity
0
1
2
3
4
5
6
7
8
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10
Student's name selling the coffee/tea
*
I will pay via... (the coffee/tea will not be ordered until the payment is received)
*
give cash/check to the student fundraising
mail cash/check to YL (2033 S 33rd St. Lincoln, NE 68506)
venmo @Alie-Gillespie-1
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