Burleigh Manor Music Pie Fundraiser
Student Name
First Name
Last Name
Contact Number
-
Area Code
Phone Number
Student Homeroom Teacher
Teacher Last Name
Street Address Line 2
City
State / Province
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Customer #1 Order Information
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*
Customer Phone Number (optional)
-
Area Code
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Order Information
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Caramel Apple Nut Hi Pie (Item #5481)
$
19.00
Quantity
1
2
3
5
6
7
8
9
10
Lemon Icebox Pie (Item #7135)
$
17.00
Quantity
1
2
3
4
5
6
7
8
9
10
Gourmet Apple Hi Pie (Item #9270)
$
16.00
Quantity
1
2
3
4
5
6
7
8
9
10
Southern Pecan Pie (Item #9273)
$
15.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pumpkin Pie (Item #9281)
$
14.00
Quantity
1
2
3
4
5
6
7
8
9
10
Fruits of the Forest Pie (Item #9285)
$
16.00
Quantity
1
2
3
4
5
6
7
8
9
10
Chocolate French Silk Pie (Item #9299) 3
$
23.00
Quantity
1
2
3
4
5
6
7
8
9
10
Original Cheesecake (Item #12300)
$
16.00
Quantity
1
2
3
4
5
6
7
8
9
10
Strawberry Swirl Cheesecake (Item #12310)
$
16.00
Quantity
1
2
3
4
5
6
7
8
9
10
Cookies & Cream Cheesecake (Item #12320) 2
$
16.00
Quantity
1
2
3
4
5
6
7
8
9
10
Reeses P.B. Cup Cheesecake (Item #12330)
$
17.00
Quantity
1
2
3
4
5
6
7
8
9
10
Turtle Cheesecake (Item #12340)
$
17.00
Quantity
1
2
3
4
5
6
7
8
9
10
Cinnaroll (Item #371287)
$
18.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pie Note Donation
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Charitable Tax Deduction Receipt Requested?
No
Yes
Add another customer order?
No
Yes
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