Refreshement & Store Request Form - Virginia State University

VIRGINIA STATE UNIVERSITYDEPARTMENT OF RESIDENCE LIFESTORE/REFRESHMENT REQUEST FORMRevised:9/12/08Program Title:Staff Name: Phone: Email:Program Purpose:Estimated # of Attendees: Amount Requested: Amount Allocated:Request Date: Time of Event: Program Location:STORE REQUESTStore(If Off Campus – list Mailing Address,Name and Telephone Number for theStore Manager)Item (stock) Number Item Description Qty. Price Total1.2.3.4.5.6.7.8.9.10.11.12.Store Request TotalRequests are subject to alterations and denial by the program coordinator and director of residence life.

VIRGINIA STATE UNIVERSITYDEPARTMENT OF RESIDENCE LIFESTORE/REFRESHMENT REQUEST FORMFOOD REQUESTSNACKSItem Price Qty. Total CostPotato Chips (per 1oz. bag) $1.10Tortilla Chips (per 1 oz. bag) $1.10Pretzels (per 1 oz. bag) $1.10Mixed nuts (per pound) $6.50Bagels (per dozen) $10.50Whole Fresh Fruit (per dozen) $9.50DESERTSItem Price Qty. Total CostPies (per person) $2.25Cakes (per person) $2.25Sheet Cake (half – serves 50) $50.00Sheet Cake (full – serves 100) $85.00Cookies (per dozen) $8.75Blondies (per dozen) $16.25Coffee Cakes (per dozen) $8.00Brownies (per dozen) $16.25Miniature Deserts (per person) $2.50Fruit Tarts (per person) $3.50Ice Cream (per person) $6.25Doughnuts (per dozen) $10.00DRINKSItem Price Qty. Total CostIce Tea (per gallon) $10.25Fruit Punch (per gallon) $10.25Coffee (per gallon) $12.75Citrus Punch (per gallon) $10.25Assorted Bottled Juices (each) $1.60Bottled Soda (each) $1.60Bottled Water (each) $1.60Milk (each) $1.05Can Soda (each) $1.10Sparkling Cider (per gallon) $7.50Apple Cider (per gallon) $10.25PLATTERSItem Price Qty. Total CostFruit Tray (serves 25) $53.00Vegetable Tray (serves 25) $58.00Cheese Tray (serves 25) $58.00Deli Tray (per person) $12.25Salad/Deli Tray (per person) $13.25HORS D’OEUVRESItem Price Qty. Total CostBuffalo Wings (100 count) $88.00Spring Rolls (50 count) $52.00Chicken Tenders (50 count) $88.00Assorted Cold Wraps (100 count) $68.00Finger Sandwiches (100 Count) $58.00Beef or Chicken Satay (25 count) $79.00Spanakopita (25 count) $53.00Crab Dip w/ Pita Bread (25 count) MarketCrab Balls (25 count)MarketSwedish Meatballs (50 count) $37.00Barbecued Meatballs (50 count) $37.00PIZZAItem Price Qty. Total CostCheese (16” pie) $10.25Pepperoni (16” pie) $11.75Specialty (16” pie) $13.75Refreshment Request TotalStore Request TotalGrand TotalStaff Member SignatureDateApprovedResident Educator SignatureDateResidence Education Coordinator SignatureDateDirector SignatureDate