*GIFT CARD* The Home Cook January 19 & January 21st

*GIFT CARD* January 19th & January 21st (*Monday and Wednesday* Delivery)
Thank you for choosing The Home Cook! Please check the menu items below.

You can choose a selection of 2, 3, 4+ dinners.

There is a minimum of $76 for free local delivery.
2 Meals/Week: $76 (1 person) $148 (2ppl), $222 (3ppl), or $288 (4ppl)
3 Meals/Week: $114 (1 person) $222 (2ppl), $315 (3ppl), or $408 (4ppl)
4 Meals/Week: $148 (1 person) $288 (2ppl), $408 (3ppl), or $528 (4ppl)

Please note: there is an $8 fee to NY and a $5 fee to Greenwich, Monroe & Milford per delivery day.

Feel free to reach out to thehomecookct@gmail.com with any questions.

**Note: We cannot accomodate substitutions to any dish. All food will be served as described**

*Make sure that you select the protein and sides if you want to receive both.

*If you would like different quantities of food on a delivery day, please submit 2 order forms.
Full Name*

First NameLast Name
Email (please make sure this is correct)*
example@example.com
Phone Number (please make sure this is correct)*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Zip Code*
Zip Code
Date

DayMonthYear
Date
Zip Code Value
Delivery Charges Value
How would you like to get your food?*

Pick UpDelivery
Gift Card Number (IF YOU DO NOT HAVE ONE, YOU ARE USING THE WRONG FORM)*
Gift Card Amount *
Will you be leaving a cooler out?

YesNo
Please indicate where
Please click on any allergies that apply. If there are restrictions beyond what is listed below, please include in other.

Celiac (strict GF)GF (dietary preference)SesameSoyTree NutsPeanutsDairy FreeOther
How did you hear about us?
Who Referred You (first time customers only)?

Calculations
Monday Meals Total
Total Value
Wednesday Meals Total
Total Value
Monday Meals Side Dishes (Selected)
total value
Wednesday Meals Side Dishes (Selected)
total value
Total Meals (Meals Total X No. of Peoples) - hide later
total value
Total Side Dishes - (# of Sides X # of People)
monday dishes + wednesday dishes
Allowed Side Dishes (will hide it later)
total meals X 2
Extra Side Dishes (will hide it later) with price
total side dishes - allowed side dishes
Extra Side Dishes Price
Total Extra Side
Total Meals Price
Total Value
Total (Kid's Meals + Provisions + (Overnight Oats + Chicken Salad + Tuna Salad)
Delivery Charges
Total Final Amount (will hide it later)
Should be Empty:

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Catalan	Hmong Daw	Romanian
Chinese Simplified	Hungarian	Russian
Chinese Traditional	Indonesian	Slovak
Czech	Italian	Slovenian
Danish	Japanese	Spanish
Dutch	Klingon	Swedish
English	Korean	Thai
Estonian	Latvian	Turkish
Finnish	Lithuanian	Ukrainian
French	Malay	Urdu
German	Maltese	Vietnamese
Greek	Norwegian	Welsh
Haitian Creole	Persian

*GIFT CARD* January 19th & January 21st (*Monday and Wednesday* Delivery)

GIFT CARD January 19th & January 21st (Monday and Wednesday Delivery)