Blugold Dining Organic Bulk Food Order Form
Please indicate the quantity of each item, as well as the flavor, then calculate the total of your items in the columns to the right
and the grand total at the bottom. Turn in your order form to the cashier at the Snack Shack at Davies Center by MAY 6 at 3 p.m.
ALO Drink | 12 bottles per case (16.9 ounces each)
$26 x _____ = $ _____
Your Information
Please print clearly!
# ____ Allure | # ____ Appeal | # ____ Awaken | # ____ Comfort | # ____ Escape | # ____ Exposed
# ____ Light Bright
Bear Naked Granola | 6 bags per case (12 ounces each)
$38 x _____ = $ _____
Name
# ____ Chocolate Elation | # ____ Fruit and Nutty | # ____ Go Bananas ... Go Nuts! | # ____ Triple Berry
Clif Bars | 12 bars per case
$23 x _____ = $ _____
Email Address
Requested flavors: _______________________________________________________________________________
IZZE | 24 cans per case (8.4 ounces each)
$20 x _____ = $ _____
Phone Number
# ____ Apple | # ____ Blackberry | # ____ Clementine | # ____ Pomegranate
Java Monster | 12 cans per case (12 ounces each)
$24 x _____ = $ _____
# ____ Loca Moca | # ____ Mean Bean | # ____ Vanilla Light
KeVita | 12 bottles per case (15.2 ounces each)
Short Blugold Number/Student ID Number
$38 x _____ = $ _____
# ____ Blueberry Cherry | # ____ Hibiscus Berry | # ____ Mango Coconut | # ____ Mojita Lime Mint Coconut
Pickup Date
Pickup Time
# ____ Tangerine
KIND Bars | 12 bars per case
$23 x _____ = $ _____
# ____ Almond & Coconut | # ____ Blueberry Vanilla & Cashew | # ____ Cranberry Almond + Antioxidants
# ____ Dark Chocolate Cherry Cashew | # ____ Dark Chocolate Nuts & Sea Salt | # ____ Fruit & Nut Delight
# ____ Peanut Butter Dark Chocolate + Protein
Requested flavors: _______________________________________________________________________________
Monster Energy | 24 cans per case (12 ounces each)
$41 x _____ = $ _____
# ____ Original | # ____ Ultra Red | # ____ Ultra Sunrise | # ____ Zero Ultra
Naked Juice | 8 bottles per case (15.2 ounces each)
$26 x _____ = $ _____
# ____ Berry Blast | # ____ Berry Veggie | # ____ Blue Machine | # ____ Green Machine | # ____ Mighty Mango
# ____ Orange Mango | # ____ Power-C Machine | # ____ Red Machine | # ____ Strawberry Banana
NuGo Bars | 12 bars per case
$20 x _____ = $ _____
# ____ Dark Chocolate Chocolate Chip | # ____ Dark Chocolate Coconut | # ____ Dark Chocolate Pretzel
# ____ Dark Mint Chocolate Chip | # ____ Dark Mocha Chocolate | # ____ Dark Peanut Butter Cup
# ____ Gluten-Free Dark Chocolate Trail Mix
NuGo Slim Bars | 12 bars per case
$23 x _____ = $ _____
# ____ Brownie Crunch | # ____ Raspberry Truffle
Quest Bars | 12 bars per case
$31 x _____ = $ _____
# ____ Cookies & Cream | # ____ Double Chocolate Chunk | # ____ Mint Chocolate Chunk
Orders placed by Thursday
will be available for pickup
on the following Tuesday
after 2 p.m. Items not paid
for using your Blugold Card
may be paid for with cash or
check. If you want to order
items not listed on this
form, please contact Davies
Center Retail Manager Laura
Karker at 715-836-4523 or
[email protected].
# ____ S’mores | # ____ White Chocolate Raspberry
Stretch Island Fruit Strips | 30 strips per case
$19 x _____ = $ _____
# ____ Abundant Apricot | # ____ Autumn Apple | # ____ Harvest Grape | # ____ Ripened Raspberry
Orders must be picked up from
Marketplace during business hours:
# ____ Summer Strawberry
Sweet Leaf Tea | 12 bottles per case (16 ounces each)
$15 x _____ = $ _____
# ____ Citrus Green Tea | # ____ Mint & Honey Green Tea | # ____ Original Sweet Tea | # ____ Peach Iced Tea
Tropicana | 12 bottles per case (15.2 ounces each)
$21 x _____ = $ _____
# ____ Farmstand Tropical Green | # ____ Grape | # ____ No-Pulp Orange
# ____ No-Pulp Orange with Calcium + Vitamin D | # ____ Orchard-Style Apple
Virgil’s Sodas | 24 bottles per case (12 ounces each)
$42 x _____ = $ _____
# ____ Black Cherry Cream Soda | # ____ Butterscotch Beer | # ____ Cream Soda | # ____ Orange Cream Soda
# ____ Root Beer
Grand Total $ __________
Monday - Thursday: 7 a.m. to 7 p.m.
Friday: 7 a.m. to 4 p.m.
Saturday & Sunday: 11 a.m. to 3 p.m.
The latest pickup time
is May 20 at 1 p.m.
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@BlugoldDining
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