Vancouver Island, BC Owned & Operated - in the beautiful Comox Valley!

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 $6.75
		Quantity
1-401YP	Chicken, 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: $1.25 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

Phone: (250) 339-2625 Fax: (250) 339-1076 Toll Free (on Vancouver Island): 1-866-216-2655