Dyatmika-School-Lunch-Pre-Order-Form-September-2024

SCHOOL LUNCH PRE-ORDER FORM
* Required
Student Name*

First NameLast Name
Date of Birth

MonthDayYear
Class/Grade
Homeroom
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Mobile Number *
Special Notes
Home Delivery (+10k per meal)
Home Delivery Charges
Parent/Guardian Address

Street Address

Street Address Line 2

CityArea

Postal / Zip Code
Does your child have any Allergies
Our Chefs take pleasure in preparing daily fresh snacks and meals for you in Dyatmika School Kitchen.
To ensure we can accommodate your preferences, please place your lunch orders in advance by September 1st.

Thank you for your cooperation.

LUNCH PACKAGE (21 DAYS) MON 02 SEP - FRI 04 OCT 2024

PACKAGE PRICE

Lunch : 735.000 [35.000/Lunch]
Healthy Snack : 315.000 [15.000/Snack]
Fresh Juice : 315.000 [15.000/Juice]
Please choose*

PrimarySecondary
Payment Method

TransferCredit Card (NEW: this form is offering credit card payment now. Easy and Safe)Paypal (dwi.surya1183@gmail.com)
Does your child follow any special diet?

VegetarianVegan (+15k per meal)Gluten free (+15k per meal)Diary freeNoOther
Vegan and Gluten Values
Order your meals here! We offer two menu options daily. If your child doesn't prefer Menu 1 or Menu 2, simply click "Daily available choices" to see our most popular options.

Final Calculations
Days in Weeks Total
Snack + Juice Total
Final Value
Final Price
Total Amount To Be Paid

prevnext( X )
IDRPlease HELP US by sending us your transfer receipt.
Follow us at:
OR Contact Us at:

www.cantina-canggu.com

WA +62 895 0556 3046
Should be Empty:

SCHOOL LUNCH PRE-ORDER FORM