Date:		Phone:
District:			Fax:
School:
Mailing Address:
City:		State:		Zip:
	CAP COUNT	CAP COUNT		AUTHORIZED
DATE	GAL / HGL	SINGLE SERVE	PRINCIPAL	SIGNATURE
		Please share with us!
		What is your school/PTA saving for?
		(Books, party, playground equiptment etc.)
			Cream o'Weber Dairy
Cap Total:			4282 West 1730 South
X	$            0.05	$          0.02	Salt Lake City, UT  84104
Total			801-973-9922
			Please Fax To:
Reimbursement:			Fax: 801-977-5053
			Attn:  Patti Butterfield, Ext. 332
			And  we will arrange to pick up your caps.