Yomie's Order Form
Yomie's Rice X Yogurt is hosting a fundraiser event for Annandale High School's Orchestra. All orders would need to be submitted and paid by Monday, 12/12/2022. Order distribution is on Wednesday, 12/14/2022, from 3:00PM-3:30PM in the Orchestra room or in our store. Please contact Yomie's Rice X Yogurt at info@yomiesriceyogurt.com if you have any questions. Thank you!
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Mochi Donut
Top Seller Yogurt Smoothie
Fresh Fruit Yogurt Smoothie
Fresh Fruit Tea
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Mochi Donut
Mochi Donut Assorted (3 donuts per box)
Please list any allergies in the Special Instructions section
$
9.75
Quantity
1
2
3
4
5
6
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9
10
Mochi Donut Assorted (6 donuts per box)
Please list any allergies in the Special Instructions section
$
16.50
Quantity
1
2
3
4
5
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9
10
Mochi Donut Assorted (12 donuts per box)
Please list any allergies in the Special Instructions section
$
33.00
Quantity
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9
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Top Seller Yogurt Smoothie
Yomie's Purple Rice Yogurt
$
6.25
Sugar Level
Quantity
Regular
1
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10
Extra Sugar
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Less Sugar
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10
No Sugar
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Yomie's Oats Yogurt
$
6.25
Sugar Level
Quantity
Regular
1
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10
Extra Sugar
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Less Sugar
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No Sugar
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9
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Oreo Yogurt
$
6.50
Sugar Level
Quantity
Regular
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10
Extra Sugar
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Less Sugar
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9
10
No Sugar
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9
10
Matcha Yogurt
$
6.75
Sugar Level
Quantity
Regular
1
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9
10
Extra Sugar
1
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9
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Less Sugar
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9
10
No Sugar
1
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9
10
Fresh Fruit Yogurt Smoothie
Mango Yogurt
$
6.50
Sugar Level
Quantity
Regular
1
2
3
4
5
6
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8
9
10
Extra Sugar
1
2
3
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5
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7
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9
10
Less Sugar
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5
6
7
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9
10
No Sugar
1
2
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4
5
6
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8
9
10
Strawberry Yogurt
$
6.50
Sugar Level
Quantity
Regular
1
2
3
4
5
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9
10
Extra Sugar
1
2
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5
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8
9
10
Less Sugar
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6
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9
10
No Sugar
1
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9
10
Hawaiian Banana Yogurt
$
6.50
Sugar Level
Quantity
Regular
1
2
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9
10
Extra Sugar
1
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9
10
Less Sugar
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9
10
No Sugar
1
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8
9
10
Passion Fruit Yogurt
Contains passion fruit seeds
$
6.75
Sugar Level
Quantity
Regular
1
2
3
4
5
6
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8
9
10
Extra Sugar
1
2
3
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5
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9
10
Less Sugar
1
2
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4
5
6
7
8
9
10
No Sugar
1
2
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5
6
7
8
9
10
Avocado Yogurt
$
6.95
Sugar Level
Quantity
Regular
1
2
3
4
5
6
7
8
9
10
Extra Sugar
1
2
3
4
5
6
7
8
9
10
Less Sugar
1
2
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6
7
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9
10
No Sugar
1
2
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5
6
7
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9
10
Fresh Fruit Tea
Genki Forest Lemon Green Tea
$
5.75
Sugar Level
Quantity
Regular
1
2
3
4
5
6
7
8
9
10
Extra Sugar
1
2
3
4
5
6
7
8
9
10
Less Sugar
1
2
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4
5
6
7
8
9
10
No Sugar
1
2
3
4
5
6
7
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9
10
Four Season Passion Fruit Green Tea
Contains passion fruit seeds
$
5.95
Sugar Level
Quantity
Regular
1
2
3
4
5
6
7
8
9
10
Extra Sugar
1
2
3
4
5
6
7
8
9
10
Less Sugar
1
2
3
4
5
6
7
8
9
10
No Sugar
1
2
3
4
5
6
7
8
9
10
Grape Green Tea Smoothie
$
5.95
Sugar Level
Quantity
Regular
1
2
3
4
5
6
7
8
9
10
Extra Sugar
1
2
3
4
5
6
7
8
9
10
Less Sugar
1
2
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4
5
6
7
8
9
10
No Sugar
1
2
3
4
5
6
7
8
9
10
Korean Corn Dog
Original Dog
Coated with crispy panko
$
4.49
Inner Filling
Quantity
Sugar Level
Price
All-Beef Hot Dog
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
4.49
Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
4.99
Half All-Beef & Half Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
5.19
Ramen Dog
Coated with crispy ramen
$
5.49
Inner Filling
Quantity
Sugar Level
Price
All-Beef Hot Dog
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
5.49
Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
5.99
Half All-Beef & Half Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
6.19
Potato Dog
Coated with crispy potatoes
$
5.49
Inner Filling
Quantity
Sugar Level
Price
All-Beef Hot Dog
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
5.49
Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
5.99
Half All-Beef & Half Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
6.19
Spicy Cheese Puff Dog
Coated with medium spicy cheese puffs
$
5.99
Inner Filling
Quantity
Sugar Level
Price
All-Beef Hot Dog
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
5.99
Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
6.49
Half All-Beef & Half Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
6.49
Hot Cheetos Dog
Coated with hot cheetos
$
5.99
Inner Filling
Quantity
Sugar Level
Price
All-Beef Hot Dog
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
5.99
Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
6.49
Half All-Beef & Half Mozzarella Cheese
1
2
3
4
5
6
7
8
9
10
Regular
Extra Sugar
Less Sugar
No Sugar
$
6.49
Special Instructions
Order Pickup Location
*
Annandale High School Orchestra room
Yomie's Rice X Yogurt (4367 John Marr Drive, Annandale, VA)
Payment Method
*
Venmo (Preferred Method)
Credit Card
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Cardholder Full Name:
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Billing Zip Code:
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Reminders:
After submitting this form, we'll check your order and contact you within 24-48 hours for confirmation.
A confirmation email will be sent with payment instructions if payment has not been received.
All sales are final. No refunds or exchanges are accepted.
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