Account Number
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Route Number
Date
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YYYY
Your Name
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Phone
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(###)
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Email
Do you need an order this week?
*
If you checked yes, fill out your order below.
Do you need gallons of Polka Dot milk?
Please select which ones you need below.
If you checked any of the boxes above for gallons, please enter the quantities needed for each one below.
For Example: 208-8, 209-4, 210-12, 211-2
Do you need half gallons of Prairie Farms milk?
Please select which ones you need below.
If you checked any of the boxes above for half gallons, please enter the quantities needed for each one below.
Do you need quarts of Prairie Farms milk?
Please select which ones you need below.
If you checked any of the boxes above for quarts, please enter the quantities needed for each one below.
Do you need pints of Praire Farms milk?
Ordered in quantities of 12. Please Select which ones you need below.
If you checked any of the boxes above for pints, please entered the quantities needed for each one below.
Do you need any Nesquik?
Ordered in quantities of 12. Please select which ones you need below.
If you checked any of the boxes above for nesquik, please enter the quantities needed for each one below.
Do you need any 1/2 pints of Kemps milk?
Please select which ones you need below.
If you checked any of the boxes above for 1/2 pints, please enter the quantities needed for each one below.
Do you need any half and half or whipping cream?
Please select which ones you need below.
If you checked any of the boxes above for half and half or whipping cream, please enter the quantities needed for each one below.
Do you need any Cultured Products?
Please select which ones you need below.
If you checked any of the boxes above for cultured products, please enter the quantities needed for each one below.
Do you need any gallon drinks?
Please select which ones you need below.
If you checked any of the boxes above for gallon drinks, please enter the quantities needed for each one below.
Do you need any water?
Please select which ones you need below.
If you checked any of the boxes above for water, please enter the quantities needed for each one below.
Do you need any juice?
Please select which ones you need below.
If you checked any of the boxes above for juice, please enter the quantities needed for each one below.
Do you need any creamers?
313, 314, 315 ordered in quantities of 6. Please select which ones you need below.
If you checked any of the boxes above for creamers, please enter the quantities needed for each one below.
Do you need any butter?
Please select which ones you need below.
If you checked any of the boxes above for butter, please enter the quantities needed for each one below.
Do you need any eggs?
Please select which ones you need below.
If you checked any of the boxes above for eggs, please enter the quantities needed for each one below.
Do you need any egg nog?
Note this product is seasonal. Please select which ones you need below.
If you checked any of the boxes above for egg nog, please enter the quantities needed for each one below.
Do you need any soft serve ice cream?
Please select which ones you need below.
If you checked any of the boxes above for soft serve ice cream, please enter the quantities needed for each one below.
Do you need any milk dispensers?
Please select which ones you need below.
If you checked any of the boxes above for dispensers, please enter the quantities needed for each one below.
Do you need any half gallons of whipping cream or buttermilk?
Please select which ones you need below.
If you checked any of the boxes above for half gallons of whipping cream or buttermilk, please enter the quantities needed for each one below.
Do you need any 2 or 5 pound cultured products?
Please select which ones you need below.
If you checked any of the boxes above for 2 or 5 pound cultured products, please enter the quantities needed for each one below.
Do you need any 12 count boxes of shredded cheese?
Please select which ones you need below.
If you checked any of the boxes above for 12 count boxes of shredded cheese, please enter the quantities needed for each one below.
Do you need any 8 oz bags of shredded cheese or american cheese slices?
Please select which ones you need below.
If you checked any of the boxes above of 8 oz bags of shredded cheese or american slices, please enter the quantities needed for each one below.
Do you need any 12 oz North Country cheese curds?
Please select which ones you need below.
If you checked any of the boxes above for 12 oz North Country cheese curds, please enter the quantities needed for each one below.
Do you need any Ellsworth cheese curds?
Please select which ones you need below.
If you checked any of the boxes above for Ellsworth cheese curds, please enter the quantities needed for each one below.
Do you need any 8 oz Cheese Pleasers blocks?
Please select which ones you need below.
If you checked any of the boxes above for 8 oz cheese pleasers blocks, please enter the quantities needed for each one below.
Do you need any 3 oz Country Fresh products?
Note this product comes in 6 packs. Please select which ones you need below.
If you checked any of the boxes above for 3 oz Country Fresh products, please enter the quantities needed for each one below.
Do you need any 5 oz Husnik Meat Products?
Please select which ones you need below.
If you checked any of the boxes above for 5 oz Husnik meat products, please enter the quantities needed for each one below.
Do you need any 48 or 24 count boxes of cookies?
Please select which ones you need below.
If you checked any of the boxes above for 48 or 24 count boxes of cookies, please enter the quantities needed for each one below.
Do you need any candy?
Please select which ones you need below.
If you checked any of the boxes above for candy, please enter the quantities needed for each one below.
Do you need any Aloe Vera?
Note this product is ordered in quantities of 20. Please select which ones you need below.
If you checked any of the boxes above for Aloe Vera, please enter the quantities needed for each one below.
Do you need any Dots pretzels?
Please select which ones you need below.
If you checked any of the boxes above for Dots pretzels, please enter the quantities needed for each one below.
Do you need any Von Hanson's pretzels?
Please select which ones you need below.
If you checked any of the boxes above for Von Hanson's pretzels, please enter the quantities needed for each one below.
Do you need anything else?
Please enter the item name and/or number and quantities for each additional item below.
