UCLA Coffee Service Order Form
UCLA Coffee Service Order Form
Three ways to order! 1) Online: coffee.ucla.edu 2) E-mail list of items to: coffee@ha.ucla.edu or 3) Fax this completed form to: x61482.
Don¡¯t see a favorite item here? Call us at x57735. No charge for special orders. Ask about our complimentary coffee brewing equipment program.
Date:
Contact Name:
Dept. & Mail Code:
Delivery (Building & Room Number):
GROUND COFFEES
Coffee Bean & Tea Leaf
24-packet case (2 oz. packets)
? Colombia Nari?o
Fair Trade Blend
? French Roast
? French Vanilla
? Hazelnut
? House Blend
? House Decaf
? Sumatra
? Viennese Blend
18-packet case (2.5 oz. packets)
? French Roast
? House Blend
Peet¡¯s ¡ª 18-packet box (2.5 oz. packets)
? House Blend
? Major Dickason¡¯s Blend
Seattle¡¯s Best ¡ª 18-packet box (2 oz. packets)
? 6th Avenue Bistro
? Portside Blend
Starbucks
18-packet box (2.5 oz. packets)
? Caff¨¨ Verona
? Blonde Veranda Blend
? Pike Place
? Pike Place Decaffeinated
One pound bag:
? Pike Place Decaffeinated
? Pike Place Regular
Additional Brands (36-packet case)
? Folgers Classic Roast (0.9 oz. packets)
Qty.
Total
$33.00/case
$32.00/case
$32.50/case
$37.00/case
$37.00/case
$32.00/case
$39.50/case
$39.00/case
$39.00/case
________
________
________
________
________
________
________
________
________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
$34.50/case
$36.00/case
________
________
0.00
$__________
0.00
$__________
$47.00/box
$47.00/box
________
________
0.00
$__________
0.00
$__________
$31.00/case
$31.00/case
________
________
0.00
$__________
0.00
$__________
$47.00/box
$47.00/box
$47.00/box
$47.00/box
________
________
________
________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
$17.50/lb.
$17.50/lb.
________
________
0.00
$__________
0.00
$__________
$29.00/case
________
0.00
$__________
Price
$18.25/box
Qty.
________
Total
0.00
$__________
$18.25/box
$18.25/box
$18.25/box
$18.25/box
$18.25/box
$18.25/box
$23.25/box
$23.25/box
________
________
________
________
________
________
________
________
0.00
$___________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
DRINKS
Coca-Cola (24-can case)
Coke Zero (24-can case)
Diet Coke (24-can case)
Dr. Pepper (24-can case)
Orange Fanta (24-can case)
Sprite (24-can case)
Arrowhead Bottled Water (24-bottle case)
Nestl¨¦ Pure Life Bottled Water (48-bottle case)
Perrier Bottled Mineral Water (4-bottle case)
Perrier Bottled Mineral Water (24-bottle case)
100% Fruit Juices (24-bottle case)
Price
$15.00
$15.00
$15.00
$15.00
$15.00
$15.00
$15.00
$17.00
$5.95
$35.75
$36.00
Qty.
________
________
________
________
________
________
________
________
________
________
Total
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
Please call for specific variety.
HOT CHOCOLATE
Swiss Miss Regular (50 packets)
Swiss Miss Sugar-Free (24 packets)
Price
$10.50
$8.50
Qty.
________
________
K-CUPS
Donut Shop Original (24-cup box)
Green Mountain (24-cup box)
? Breakfast Blend
? Caramel Vanilla
? Dark Magic
? French Roast
? French Vanilla
? Hazelnut
Peet¡¯s French Roast (22-cup box)
Starbucks Caf¨¦ Verona (24-cup box)
Sustainable Product
09/21
Price
Total
0.00
$__________
0.00
$__________
Phone:
E-Mail:
Recharge ID#:
TEAS
Bigelow Teas (28 tea bags/box)
? Apple & Cinnamon
? Constant Comment
? Darjeeling
? Earl Grey
? English Teatime
? Green Tea
? Green Tea (decaffeinated)
? Jasmine Green Tea
? Orange Spice
? Vanilla Chai
? Cozy Chamomile (herbal/caffeine-free)
? Cranberry Apple (herbal/caffeine-free)
? I Love Lemon (herbal/caffeine-free)
? Mint Medley (herbal/caffeine-free)
Choice Organic Teas (16 tea bags/box)
Classic Green Tea
Earl Grey Tea
English Breakfast Tea
Jasmine Green Tea
Lipton Tea (100 tea bags/box)
Lipton Tea, Decaffeinated (72 tea bags/box)
Fund/Account:
Price
Qty.
Total
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
$4.75
________
________
________
________
________
________
________
________
________
________
________
________
________
________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
$5.25
$5.25
$5.25
$5.25
$7.25
$9.50
________
________
________
________
________
________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
CREAMERS & SWEETENERS
Price
Coffee-Mate Powdered Creamer (11 oz. canister)
$3.00
Coffee-Mate Powdered Creamer Packets (1,000/box) $55.00
Coffee-Mate Liquid Creamer
Individual Servings (180/box)
? Original
$17.00
? French Vanilla
$22.00
? Hazelnut
$22.00
? Irish Cream
$22.00
Pump (1.5 L)
? Original
$24.00
? French Vanilla
$24.00
? Hazelnut
$24.00
Carnation Powdered Creamer (15 oz. canister)
? French Vanilla
$5.00
? Hazelnut
$5.00
Land O¡¯ Lakes Mini-Moo¡¯s Half & Half (180/box)
$17.50
C&H Sugar (20 oz. canister)
$3.00
Sugar Packets (1,000/case)
$15.00
Sugar in the Raw (200/box)
$12.50
Fair Trade Raw Sugar (500/box)
$22.50
Equal Sweetener (100/box)
$5.50
Sweet¡¯N Low (100/box)
$7.00
Splenda (100/box)
$7.50
Splenda (400/box)
$31.00
Splenda (2,000/box)
$51.50
Honey Packets (200/box)
$44.00
Qty.
________
________
Total
0.00
$___________
0.00
$___________
________
________
________
________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
________
________
________
0.00
$__________
0.00
$__________
0.00
$__________
________
________
________
________
________
________
________
________
________
________
________
________
________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
SUPPLIES
Paper Cups, 8 oz. (50/sleeve)
Paper Cups, 12 oz. (50/sleeve)
Biodegradable Cups, 12 oz. (50/sleeve)
Stir Sticks ¡ª Wooden (1,000/box)
Napkins (500/pack)
Coffee Filters (50/pack)
Coffee Pot Brush
Coffee Pot Cleaner (12 oz. bottle)
Individually Wrapped Knives
Individually Wrapped Forks
Individually Wrapped Spoons
Knives, Forks & Spoons (100/packet)
Plates ¡ª 6¡± (125/packet)
Plates ¡ª 10¡± (125/packet)
Qty.
________
________
________
________
________
________
________
________
________
________
________
________
________
________
Total
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
0.00
$__________
Price
$3.00
$4.00
$7.00
$3.00
$7.00
$0.75
$8.00
$4.00
$0.10
$0.10
$0.10
$2.00
$9.50
$21.00
ORDER TOTAL: $
0.00
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