Milk Order Milk Order Form Please use this form to order milk for your student(s) for the year. Student Name 1 First Last Student 1 Grade Student Name 2 First Last Student 2 Grade Student Name 3 First Last Student 3 Grade Student Name 4 First Last Student 4 Grade Milk orders Quantity Price: $16.00 Quantity Enter the number of milks for each day. Cost is $16.00 per year per studentTotal Credit CardCard Details Cardholder Name Parent/Guardian Email(Required) Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code