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

________

________

________

________

________

________

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________

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

________

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________

________

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________

________

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

$__________

________

________

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________

________

________

________

________

________

________

________

________

________

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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