Big Wheels Order Form Big Wheels 2022 Order Form All Orders must be submitted by 5 p.m. on TUESDAY, April 19.Business Name* Deliver To:* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Any Special Instructions for Delivery:Your meals are usually delivered between 10:00 and 11:00 am unless specifiedContact Name* Contact Email* Contact Phone*OrderPanera Deli Turkey Lunch Price: $12.00 Quantity: (Sliced roasted turkey breast, emerald greens, tomatoes, red onion on freshly baked whole grain, chips, and cookie) Panera Grilled Chicken Lunch Price: $12.00 Quantity: (Sliced grilled chicken breast served cold, emerald greens, tomatoes, red onion, on freshly baked white whole grain. Chips and cookie.)Panera Mediterranean Veggie Lunch Price: $12.00 Quantity: (Hummus, peppadew peppers, feta, cucumber, emerald greens, tomatoes, red onion, on freshly baked ciabatta. Chips and cookie)Panera Tuna Salad Lunch Price: $12.00 Quantity: (Tuna salad, emerald greens, tomatoes, red onion, on freshly baked ciabatta. Chips and cookie.)Additional contribution to Meals on Wheels (fully tax deductible) HiddenTotal Order QuantityTotal $0.00 Date to be delivered:*Monday, April 25Tuesday, April 26Wednesday, April 27Thursday, April 28Friday, April 29Orders due by 5 P.M. on Tuesday, April 19. Note: Minimum delivery is 3 lunches. Your meals are usually delivered between 10:00 and 11:00am unless specified. If ordering lunches for multiple days, please submit a form for each day. Thank you so much for helping us feed Columbia's Seniors. Meals on Wheels of Columbia is a 100% locally funded agency. Each box lunch will receive a $6 tax deductible card in the lunch with a list of our sponsors.How will you be paying?* Cash or Check Credit Card Pre Pay Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Your order has less than the minimum requirement of 3 meals. Please update your meal total to enable the checkout.CommentsThis field is for validation purposes and should be left unchanged. Δ
