Valley Home Meals POTASSIUM RESTRICTED Order Form

1. Your Contact Information:     Name Email Phone Address Address Address Postal code    BC, Canada     2. Food Allergies/Notes:     3. MENU Please enter quantities for the menu items you would like to order:     Combo Pack Information: To qualify for combo pack pricing, simply choose any 15 or more entrees or individual dinners of your choice (click here for more information)     Potassium Restricted Small Entrees $6.00     Quantity 1-401YP Turkey, Gravy, Green Beans, Carrots and Rice 1-402YP Roast Pork, Gravy,  Turnip, Green Beans and Rice 1-403YP Chicken, Gravy,  Cauliflower, Green Beans and Pasta 1-404YP Salisbury Steak, Gravy, Corn, Green Beans and Rice 1-407YP Chicken Stuffed with Ham & Swiss Cheese, Broccoli, Carrots and Rice 1-408YP Bangers, Peas, Carrots and Rice       2-402GP Chicken, Gravy,  Green Beans, Corn and Rice 2-404GP Pork Chop, Gravy, Turnip, Green Beans and Pasta 2-405GP Roast Beef, Gravy, Green Beans, Carrots  and Rice             Substitutions: $1.00 extra Please list any substitutions below:         If you would prefer to print and fill out an order form,   Click here for a printer-friendly order form (30kb)

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