Order Form Piedmont Regional Jail Authority Effective June 2020 Please Complete All Info on Reverse (Print Clearly)

Order Form Piedmont Regional Jail Authority Effective June 2020 Please complete all info on reverse (print clearly).

TOTAL TOTAL ITEM DESCRIPTION PRICE ITEM # Size QTY PRICE ITEM DESCRIPTION PRICE ITEM # Size QTY PRICE DRINKS Chips & Snacks Coffee 7 Days 3.17 oz. Roasted Garlic Bagel Chips K $1.70 / EA 80007192 Cafe Bustelo 3.5 oz. Coffee Pouch K H $7.60 / EA 10870 Cheetos 1.75 oz. Flamin’ Hot Crunchy G $1.25 / EA 7690 Keefe 3 oz. Colombian Blend Premium Coffee K H R V $2.90 / EA 10244 Doritos 1.75 oz. Nacho Cheese Chips $1.25 / EA 10513 Maxwell House 4 oz. Dark Roast Espresso K H C R $5.50 / EA 10704 Fiddle Faddle 6 oz. Caramel Popcorn w/Peanuts K $2.40 / EA 6606 Tea Fritos 3.25 oz. Regular Corn Chips $1.30 / EA 80007737 Bigelow 1.1 oz. Variety Pack Assorted Teas (18 Ct.) K H G $6.20 / BX 428 Kellogg’s 0.78 oz. Birthday Cake Rice Krispies Treats $0.80 / EA 80006361 Sweetener Splenda .035 oz. Single Serve Pack D $0.10 / EA 6467 Kings Nut 3.25 oz. Roasted & Salted Sunflower Kernels K H $0.90 / EA 80003356

Drink Mixes Moon Lodge 6 oz. Sour Cream & Onion Potato Chips K H G $2.95 / EA 5113 Crystal Light SF Raspberry Lemonade Drink Stick (6 Pk.) $2.55 / SP 80004848 Snyder’s 2.25 oz. Honey Mustard and Onion Pretzel Pieces K D $1.15 / EA 9553 Crystal Light Wild Strawberry Sugar Free Energy Drink Stick $2.55 / SP 80004849 (6 Pk.) Snyder’s 2.25 oz. Hot Buffalo Wing Pretzel Pieces K D $1.15 / EA 6108

Nutritional Drinks The Whole Shabang 2 oz. Pork Rinds D $1.50 / EA 80003053 New Leaf 2 oz. Chocolate Health Shake Mix K $1.90 / EA 80003592 The Whole Shabang 6 oz. Original Potato Chips K H $3.50 / EA 5114 New Leaf 2 oz. Vanilla Health Shake Mix K $1.90 / EA 80003593 Nuts FOOD & SNACKS Kar’s 3.5 oz. Butter Toffee Peanuts K $1.65 / EA 80001220 Cereal Kar’s 3.5 oz. Honey Peanuts $1.45 / EA 80006011 Cheerios 1.3 oz Cereal Cup Single Serve $2.65 / EA 80006663 Kar’s 3.5 oz. Sriracha Peanuts K D $1.45 / EA 80001033 Cinnamon Toast Crunch 2 oz Cereal Cup Single Serve $2.65 / EA 80006664 Crackers Kellogg’s 3.1 oz. Fruit Loops Cereal Resealable Package $2.15 / EA 80006255 Austin Peanut Butter and Jelly Sandwich Crackers (8 Pk.) K $3.20 / BX 80007340 Kellogg’s 3.6 oz. Frosted Flakes Resealable Bag K $2.15 / EA 80006254 Austin Pepperjack Sandwich Crackers (8 Pk.) K $3.20 / BX 80007339 Oatmeal Cheez-It 1.5 oz. Hot & Spicy Crackers K $0.70 / EA 4214 Quaker Instant Oatmeal Maple & Brown Sugar (10 Pk.) $4.10 / SP 80004559 Cheez-It 2 oz. White Cheddar Crackers $1.15 / EA 10706 Toaster Pastries Kellogg’s 13.5 oz. Frosted Brown Sugar Cinnamon Pop Tarts $4.00 / BX 80008116 Cookies (8 PK.) Bud’s Best 5.5 oz. Candy ‘n Cookies - Butterfinger Mini Cookies $1.95 / EA 6386 K Kellogg’s 13.5 oz. Frosted Strawberry Pop Tarts 8 (Pk.) $4.00 / BX 80008118 Bud’s Best 6 oz. Peanut Butter ‘n Graham Cookies $1.95 / EA 10352 Pastries & Snack Cakes 7 Days 2.65 oz. Chocolate Croissant K $1.70 / EA 80007188 Bud’s Best 6 oz. Pecan Chocolate Chip Supreme Cookies $1.95 / EA 9697

Hostess 5 oz. Berries & Cream Cheese Danish $2.25 / EA 80002460 Grandma’s 2.5 oz. Soft Peanut Butter Cookies $0.85 / EA 7790

Market Square Bakery 5 oz. Jumbo Chocolate Iced Honey $1.55 / EA 6540 Nabisco 2.4 oz. Oreo Cookies $1.10 / EA 80003305 Bun K C Uncle Al’s 5 oz. Chocolate Cremes Cookies $1.20 / EA 5792 Mrs. Freshley’s 4.5 oz. Apple Fruit Pie K $1.35 / EA 9739

TOTAL TOTAL ITEM DESCRIPTION PRICE ITEM # Size QTY PRICE ITEM DESCRIPTION PRICE ITEM # Size QTY PRICE Candy Fresh Catch 3.53 oz. Chunk Light Tuna w/Jalapenos K D $2.85 / EA 80005516 Atkinson’s 3.75 oz. Sugar Free Crunchy Peanut Butter Bars K C $3.00 / EA 9764 Fresh Catch 3.53 oz. Fillets of Mackerel in Soybean Oil H D G $2.25 / EA 4385 Atomic 3 oz. Fireball $1.15 / EA 80006095 Fresh Catch 3.53 oz. Fish Steaks in Louisiana Hot Sauce H D G $1.95 / EA 4397 Chewy Lemonheads 4 oz. Redrific Candy $1.30 / EA 80006094 Fresh Catch 3.53 oz. Mackerel in Sriracha Hot Chili $2.60 / EA 9703 Sauce H D G S GoLightly 2.75 oz. Sugar Free Butterscotch Candy K C D $3.00 / EA 6329 Fresh Catch 3.53 oz. Sardines in Hot Tomato Sauce H D G S $1.20 / EA 4386 GoLightly 2.75 oz. Sugar Free Starlight Mints K C D $3.00 / EA 6330 Ready-To-Eat Meals GoLightly 2.75 oz. Sugar Free Vanilla Caramels K C D $3.00 / EA 6331 Brushy Creek 11.25 oz. Chili with Beans Hot! G $2.95 / EA 1712 Mayfair Select Sweets 5 oz. Caramel Creams C $2.05 / EA 10347 Brushy Creek 5 oz. Pulled Chicken in Buffalo Style Sauce D G $4.90 / EA 6476 Mayfair Select Sweets 6.5 oz. Peach Rings C $2.05 / EA 10345 Rip ‘N’ Ready 10 oz. Meatballs with Spaghetti Sauce H $5.50 / EA 3971 Nestle 4 oz. Chocolate Parfait Nips $1.70 / EA 80001073 Rip ‘N’ Ready 10 oz. Roast Beef in Gravy $6.25 / EA 80007676 Now & Later 3.25 oz. Assorted Candy $1.55 / EA 80006096 Vegetables Swedish Fish 3 oz. Red Candy C $1.40 / EA 80005733 Idahoan 4 oz. Applewood Smoked Bacon Mashed Potatoes $3.55 / EA 80001605

Zachary 5.5 oz. Thin Mints $2.60 / EA 5234 Keefe Kitchens 4 oz. Instant Potatoes K H $2.05 / EA 10931

Salad Dressing Rice & Beans Kraft 1.5 oz. Thousand Island Dressing Packet $0.50 / EA 5924 Brushy Creek 10 oz. Black Beans G $2.15 / EA 4915

Spreads Brushy Creek 8 oz. Cajun Style Rice with Chicken & Sausage $4.00 / EA 80003084 Keefe Kitchen’s 18 oz. Creamy Peanut Butter Pouch K H R $5.15 / EA 80001236 Keefe Kitchens 6.5 oz. Pre-Cooked Long Grain Brown Rice $2.05 / EA 7525 K C R G Cheese Cactus Annie’s 2 oz. Jalapeno Cheese Squeeze Snack G $1.00 / EA 2585 Minute Rice 8 oz. White Rice Clear Resealable Pouch $1.60 / EA 80005364

Old Fashioned .75 oz. Cream Cheese $0.80 / EA 80002189 Sevilla 4.4 oz. Chili Flavor Refried Beans & Rice K H $1.65 / EA 5939

Velveeta 4 oz. Nacho Cheese Dip w/Jalapenos Snack Spread $1.60 / EA 9398 Velveeta 4 oz. Spicy, Cheesy Refried Beans K H C $1.75 / EA 4940 Tub C R G Velveeta 4 oz. Spicy, Cheesy Refried Beans & Rice K H C $1.75 / EA 4941 Meat Snacks Brushy Creek 5 oz. Beef Salami Stick D G $3.25 / EA 80001739 Zatarain’s 8.8 oz. Big Easy Rice - Jambalaya $5.05 / EA 10453

Brushy Creek 5 oz. Original Summer Sausage Made with Beef $3.40 / EA 80001720 Tortillas and Chicken G Mayan Farm 8” Whole Wheat Tortillas (10 Ct.) C $3.70 / EA 80006277 Jack Link’s .9 oz. Original Beef Jerky D $3.00 / EA 4888 Ramen Seafood Maruchan 3 oz. Chili Flavor Ramen C $1.05 / EA 10 Chicken of the Sea 2.5 oz. Pink Salmon in Sriracha Sauce K $3.00 / EA 80003004 Maruchan 3 oz. Hot & Spicy Vegetable Flavor Ramen C $1.05 / EA 505 Chicken of the Sea 3.53 oz. Sardines in Louisiana Hot Sauce K $2.25 / EA 10358 Maruchan 3 oz. Roast Chicken Flavor Ramen C $1.05 / EA 1327 Chicken of the Sea 5 oz. Light Tuna in Water K $4.75 / EA 10337 Maruchan 3 oz. Shrimp Flavor Ramen C $1.05 / EA 12

TOTAL TOTAL ITEM DESCRIPTION PRICE ITEM # Size QTY PRICE ITEM DESCRIPTION PRICE ITEM # Size QTY PRICE Maruchan 3 oz. Texas Beef Flavor Ramen C $1.05 / EA 13 Men’s Underwear Andrew Scott Men’s Boxers - White (1 Pk.) Small, Medium, $3.95 / EA 51602-01 Noodles Large, XL ______Knorr 4.4 oz. Italian Sides Creamy Garlic Shells H $3.85 / EA 7125 Andrew Scott Men’s Boxers - White (1 Pk.) 2XL $4.85 / EA 51602-01 ______Knorr 4.4 oz. Pasta Sides Alfredo Noodles $3.85 / EA 7121 Andrew Scott Men’s Boxers - White (1 Pk.) 3XL $5.85 / EA 51602-01 ______HEALTH & BEAUTY Andrew Scott Men’s Briefs - White (1 Pk.) Small, Medium, $2.99 / EA 51603-01 Hair Care Large, XL ______5” Black Comb $0.05 / EA 80000112 Andrew Scott Men’s Briefs - White (1 Pk.) 2XL, 3XL $4.15 / EA 51603-01 ______Military Style Brush $2.45 / EA 80001297 Women’s Underwear Pert Plus 13.5 oz. 2 in 1 Shampoo with Conditioner $8.10 / EA 22993 Hanes Her Way Cotton Briefs - White (3 Pk.) 6, 7, 8 $9.75 / PK 50691-01 ______Suave 2 in 1 - 12.6 oz. Shampoo and Conditioner $5.65 / EA 24869 Hanes Her Way Cotton Briefs - White (3 Pk.) 9, 10, 11, 12 $10.35 / PK 50691-01 ______

Body Wash Thermals Suave 15 oz. Everlasting Sunshine Body Wash $5.55 / EA 80004576 Indera Mills Thermal Ankle-Length Drawers - Natural Small, $6.45 / EA 50544-99 Medium, Large, XL ______Soap Indera Mills Thermal Ankle-Length Drawers - Natural 2XL, 3XL $8.05 / EA 50544-99 Dial 4 oz. Gold Soap (1 bar) $1.85 / EA 20925 ______

Indera Mills Thermal Ankle-Length Drawers - Natural 4XL, 5XL $9.95 / EA 50544-99 Skin Care ______Blistex .15 oz. SPF Medicated Lip Balm $3.20 / EA 80008058 Indera Mills Thermal Long Sleeve Shirt - Natural Small, $6.45 / EA 50543-99 Medium, Large, XL ______Infuzed 15 oz. Island Naturals Coconut Lime & Aloe Lotion $2.35 / EA 24967 Indera Mills Thermal Long Sleeve Shirt - Natural 2XL, 3XL $8.05 / EA 50543-99 ______Infuzed Island Naturals 15 oz. Shea Butter Lotion $3.00 / EA 24966 Indera Mills Thermal Long Sleeve Shirt - Natural 4XL, 5XL, 6XL $9.95 / EA 50543-99 ______Suave 10 oz. Cocoa Butter with Shea Lotion $5.55 / EA 21924 MISCELLANEOUS Deodorant Games Speed Stick 3 oz. Ultimate Sport Anti-Perspirant/Deodorant $5.45 / EA 21126 Bicycle Playing Cards $4.60 / EA 20210 Gel C D

UNO Cards $13.20 / EA 32099 Dental Care Aim 5.5 oz. Multi-Benefit Tartar Control Cool Mint Gel Tooth- $2.90 / EA 80002950 paste D

Close-Up 4 oz. Regular Gel Toothpaste $3.05 / EA 20104

Pharmaceuticals Halls Cherry Flavored Cough Drops (9 Ct.) $1.85 / EA 20244

CLOTHING & APPAREL T-Shirts Andrew Scott Select Crewneck T-Shirt - White (1 Pk.) Small, $4.45 / EA 53185-01 Medium, Large, XL D ______

Andrew Scott Select Crewneck T-Shirt - White (1 Pk.) 2XL, 3XL $4.85 / EA 53185-01 ______

Total Total K - Kosher • H - Halal • C - Clear • D - Diabetic • R - Resealable • G - Gluten Free • S - Soy Free Order Form Piedmont Regional Jail Authority Effective June 2020 Please complete all info (print clearly). PROGRAM DATES: LIMITS: Maximum $200.00 of product per inmate per week. We cannot send orders from one inmate to another. SHIP TO: Delivery to facility: Weekly Multiple packages can be ordered, and we will consolidate orders not to exceed the maximum $200.00 product per week. Inmate’s Name ID# WAYS TO ORDER: Online: piedmontpackages.com CATALOG CHANGES: Every effort has been made to show Institution/Dorm/Housing# Phone: 1.800.546.6283 and describe the merchandise as accurately as possible. Because Mail: Access Securepak (VA)10880 Linpage Place, many manufacturers change an item’s design, color, package size St. Louis, MO 63132 and style after our catalog is produced, we reserve the right to Fax: 1.866.754.2813 discontinue or change product specifications without prior notice. Street Address We regret any changes that might occur and will make every effort

City State Zip ACCEPTABLE FORMS OF PAYMENT: to minimize these occurrences. Inadvertent errors in product • Credit/Debit Cards—VISA, MasterCard, Discover descriptions, pricing and special offers are not binding on Access SENDER: REQUIRED for order fulfillment. • Prepaid cards that have a verifiable United States address Securepak, and we may make adjustments at any time. Additionally, • Cashier’s check many of our food items may contain common allergens such as • Money order milk, eggs, wheat and peanuts. Before consuming a food item, Sender’s Name We do not accept personal checks and will return them to the please consult the product packaging for specific information on its ingredients. Prices and offers are subject to change and available Street Address sender. Credit/debit and prepaid cards will be charged on the day the order is placed. Refunds or credits will be applied to the card while supplies last. Always consult the piedmontpackages.com City State Zip used for the order (allow additional time for refunds/credits on website for the latest updates on this package program. prepaid cards). Access Securepak reserves the right to remove one Phone Number or more items from the order due to insufficient payment. In the event of a back order, may we substitute like items of equal or greater value? Note: unless you choose “NO,” we may substitute for Email (You will receive confirmation emails when the order is placed and shipped) SALES TAX: Access Securepak ® is required by the state of out-of-stock or restricted items. Virginia to collect 2.5% sales tax on food and 5.3% sales tax on _YES _NO CALCULATE AMOUNT DUE: non-food items and processing fees. Merchandise TAX TOTALS CUSTOMER SERVICE: Food Items: x 1.025 = Tax calculation example: piedmontpackages.com 1.053 = Non-Food Items: x $35.25 food total x 1.025 (tax rate) = $36.13 food subtotal Automated system is available 24 hours a day, seven days a week Processing Fee: $6.95 x 1.053 = $7.32 $20.85 non- food total x 1.053 (tax rate) = $21.96 non- food subtotal 1-800-546-6283 TOTAL AMOUNT DUE: $6.95 processing fee x 1.053 (tax rate) = $7.32 processing fee Live bilingual representatives are available Monday through Friday, subtotal 8:30 a.m.–11:59 p.m. EST, and Saturday, 11 a.m.–5 p.m. EST. SELECT PAYMENT METHOD: $36.13 food subtotal + $21.96 non- food subtotal + $7.32 ¨ Cashier’s Check ¨ Money Order processing fee subtotal = $65.41 total amount due Make check or money order payable to ACCESS SECUREPAK ELIGIBILITY: Access Securepak verifies inmate eligibility before ¨ VISA ¨ MasterCard ¨ Discover shipping packages, if applicable.

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