Mississippi Food Network Secure Order Form

Mississippi Food Network
Secure Order Form

Select the item(s) below that you would like to order.
Your transaction will be confirmed by email.
Case of Beef Chili with Beans (12- 20oz cans) ($ 9.50 each) Quantity:
Case of Beef Stew (12- 20oz cans) ($ 9.50 each) Quantity:
Chicken Noodle Soup (24- 10oz cans) ($ 9.50 each) Quantity:
Case of Macaroni & Cheese (24- 7.25oz boxes) ($ 6.00 each) Quantity:
Case of Peanut Butter & Jelly (12- 18oz jars) ($ 13.00 each) Quantity:
Case of Pinto Beans (24- 1lb bags) ($ 13.00 each) Quantity:
Case of Rice (24- 1lb bags) ($ 8.00 each) Quantity:
Tomato Soup (24- 10oz cans) ($ 8.00 each) Quantity:
Case of Mixed Fruit (24- 15oz cans) ($ 13.00 each) Quantity:
Case of Vegetable Soup ($ 9.00 each) Quantity:
Case of Green Beans (24- 15oz cans) ($ 8.00 each) Quantity:
Case of Corn (24 -15oz cans) ($ 8.00 each) Quantity:
Most needed food item (MS FOOD will choose) ($ 20.00 each) Quantity:

GENERAL INFORMATION

First Name: Last Name:

Address:

City: State: Zip:

Country:

Phone Number:

E-Mail Address:

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First Name:	Last Name:
Address:
City:	State: Zip:
Country:
Phone Number:
E-Mail Address: