UCLA Coffee Service Order Form Three ways to order! 1) Online: coffee.ucla.edu 2) E-mail list of items to: [email protected] or 3) Fax this completed form to: x61482. Don’t see a favorite item here? Call us at x57735. No charge for special orders. Ask about our complimentary coffee brewing equipment program. Date: Contact Name: Phone: E-Mail: Dept. & Mail Code: Delivery (Building & Room Number): Recharge ID#: GROUND COFFEES Price Qty. Total TEAS Price Qty. Total Coffee Bean & Tea Leaf Bigelow Teas (28 tea bags/box) 24-packet case (2 oz. packets) • A p p l e & C i n n a m o n $ 4 . 7 5 ________ $ __________ • Va r i e t y P a c k $ 3 6 .0 0/c a s e ________ $ __________ • Constant Comment $4.75 ________ $ __________ • Colombia Nariño $33.00/case ________ $__________ • Darjeeling $4.75 ________ $ __________ F a i r Tr a d e B l e n d $ 3 2 .0 0/c a s e ________ $ __________ • E a r l G r e y $ 4 . 7 5 ________ $ __________ • F r e n c h R o a s t $ 3 2 . 5 0/c a s e ________ $ __________ • E n g l i s h Te a t i m e $ 4 . 7 5 ________ $ __________ • F r e n c h Va n i l l a $ 3 7.0 0/c a s e ________ $ __________ • G r e e n Te a $ 4 . 7 5 ________ $ __________ • H a z e l n u t $ 3 7.0 0/c a s e ________ $ __________ • G r e e n Te a ( d e c a ff e i n a t e d ) $ 4 . 7 5 ________ $ __________ • H o u s e B l e n d $ 3 2 .0 0/c a s e ________ $ __________ • J a s m i n e G r e e n Te a $ 4 . 7 5 ________ $ __________ • H o u s e D e c a f $ 3 9. 5 0/c a s e ________ $ __________ • O r a n g e S p i c e $ 4 . 7 5 ________ $ __________ • S u m a t r a $ 3 9.0 0/c a s e ________ $ __________ • Va n i l l a C h a i $ 4 . 7 5 ________ $ __________ • V i e n n e s e B l e n d $ 3 9.0 0/c a s e ________ $ __________ • Cozy Chamomile (herbal/caffeine-free) $4.75 ________ $__________ 18-packet case (2.5 oz. packets) • Cranberry Apple (herbal/caffeine-free) $4.75 ________ $__________ • F r e n c h R o a s t $ 3 4 . 5 0/c a s e ________ $ __________ • I Love Lemon (herbal/caffeine-free) $4.75 ________ $__________ • H o u s e B l e n d $ 3 6 .0 0/c a s e ________ $ __________ • Mint Medley (herbal/caffeine-free) $4.75 ________ $__________ Peet’s — 18-packet box (2.5 oz. packets) Choice Organic Teas (16 tea bags/box) • H o u s e B l e n d $ 4 7.0 0/ b o x ________ $ __________ C l a s s i c G r e e n Te a $ 5 .0 0 ________ $ __________ • Major Dickason’s Blend $47.00/box ________ $__________ Earl Grey Tea $5.00 ________ $ __________ Seattle’s Best — 18-packet box (2 oz. packets) English Breakfast Tea $5.00 ________ $__________ • 6th Avenue Bistro $31.00/case ________ $__________ J a s m i n e G r e e n Te a $ 5 .0 0 ________ $ __________ • P o r t s i d e B l e n d $ 3 1 .0 0/c a s e ________ $ __________ Lipton Tea ( 1 0 0 t e a b a g s / b o x ) $ 7.0 0 ________ $ __________ Starbucks Lipton Tea, Decaffeinated ( 7 2 t e a b a g s / b o x ) $ 9.0 0 ________ $ __________ 18-packet box (2.5 oz. packets) • Breakfast Blend $46.00/box ________ $__________ CREAMERS & SWEETENERS Price Qty. Total • C a ff è Ve r o na $ 4 6 .0 0/ b o x ________ $ __________ Coffee-Mate Powdered Creamer ( 1 1 o z . c a n i s te r) $ 2 . 7 5 ________ $ ___________ Fair Trade Café Estima $46.00/box ________ $__________ Coffee-Mate Powdered Creamer Packets (1,000/box) $ 5 2 .0 0 ________ $ ___________ • F r e n c h R o a s t $ 4 6 .0 0/ b o x ________ $ __________ Coffee-Mate Liquid Creamer • House Blend Regular $46.00/box ________ $__________ Individual Servings (180/box) • Pike Place Decaffeinated $46.00/box ________ $__________ • O r i g i n a l $ 1 6 .0 0 ________ $ __________ One pound bag: • F r e n c h Va n i l l a $ 2 1 .0 0 ________ $ __________ • House Blend Decaffeinated $16.95/lb. ________ $__________ • H a z e l n u t $ 2 1 .0 0 ________ $ __________ • Pike Place Regular $16.95/lb. ________ $__________ • I r i s h C r e a m $ 2 1 .0 0 ________ $ __________ Additional Brands (42-packet case) Pump (1.5 L) • Folgers Classic Roast ( 0.9 oz . p ac ke t s ) $ 2 7. 5 0/c a s e ________ $ __________ • O r i g i n a l $ 2 1 .0 0 ________ $ __________ • Yuban Decaffeinated ( 1. 5 oz . p ac ke t s) $ 3 3 .0 0/c a s e ________ $ __________ • F r e n c h Va n i l l a $ 2 1 .0 0 ________ $ __________ • Yuban Regular ( 1 . 5 o z . p a c k e t s ) $ 3 9. 5 0/c a s e ________ $ __________ • H a z e l n u t $ 2 1 .0 0 ________ $ __________ Carnation Powdered Creamer (16 oz. canister) K-CUPS Price Qty. Total • F r e n c h Va n i l l a $ 4 . 7 5 ________ $ __________ Diedrich Coffee (24-cup box) • H a z e l n u t $ 4 . 7 5 ________ $ __________ • F r e n c h R o a s t $ 1 6 .0 0/ b o x ________ $ __________ Land O’ Lakes Mini-Moo’s Half & Half ( 1 8 0/ b o x ) $ 1 6 . 5 0 ________ $ __________ • Morning Edition $16.00/box ________ $__________ C&H Sugar ( 2 0 o z . c a n i s t e r ) $ 2 . 5 0 ________ $ __________ • R i o B l e n d $ 1 6 .0 0/ b o x ________ $ __________ Sugar Packets (1,000/case) $ 1 3 . 5 0 ________ $ __________ Donut Shop Original (24-cup box) $ 1 8 . 2 5 / b o x ________ $ __________ Sugar in the Raw ( 2 0 0/ b o x ) $ 1 2 . 5 0 ________ $ __________ Green Mountain (24-cup box) Fair Trade Raw Sugar ( 5 0 0/ b o x ) $ 2 2 . 5 0 ________ $ __________ • B r e a k f a s t B l e n d $ 1 8 . 2 5 / b o x ________ $ ___________ Equal Sweetener ( 1 0 0/ b o x ) $ 5 . 5 0 ________ $ __________ • C a r a m e l Va n i l l a $ 1 8 . 2 5 / b o x ________ $ __________ Sweet’N Low ( 1 0 0/ b o x ) $ 3 . 7 5 ________ $ __________ • D a r k M a g i c $ 1 8 . 2 5 / b o x ________ $ __________ Splenda ( 1 0 0/ b o x ) $ 7. 5 0 ________ $ __________ • F r e n c h R o a s t $ 1 8 . 2 5 / b o x ________ $ __________ Splenda ( 5 0 0/ b o x ) $ 3 1 . 5 0 ________ $ __________ • F r e n c h Va n i l l a $ 1 8 . 2 5 / b o x ________ $ __________ Splenda (2,000/box) $ 5 1 . 5 0 ________ $ __________ • H a z e l n u t $ 1 8 . 2 5 / b o x ________ $ __________ Honey Packets ( 2 0 0/ b o x ) $ 3 9.0 0 ________ $ __________ Peet’s French Roast (22-cup box) $ 2 3 . 2 5 / b o x ________ $ __________ Starbucks Café Verona (24-cup box) $ 2 3 . 2 5 / b o x ________ $ __________ SUPPLIES Price Qty. Total Paper Cups, 8 oz. ( 5 0/s l e e v e ) $ 3 .0 0 ________ $ __________ DRINKS Price Qty. Total Paper Cups, 12 oz. (50/sleeve) $ 4 .0 0 ________ $ __________ Coca-Cola ( 24 - c a n c a s e ) $ 1 4 .0 0 ________ $ __________ Biodegradable Cups, 12 oz. (50/sleeve) $ 7.0 0 ________ $ __________ Coke Zero (24-can case) $ 1 4 .0 0 ________ $ __________ Stir Sticks — Plastic ( 1 ,0 0 0/ b o x ) $ 3 .0 0 ________ $ __________ Diet Coke (24-can case) $ 1 4 .0 0 ________ $ __________ Stir Sticks — Wooden ( 1 ,0 0 0/ b o x ) $ 3 .0 0 ________ $ __________ Dr. Pepper (24-can case) $ 1 4 .0 0 ________ $ __________ Napkins ( 5 0 0/p a c k ) $ 7.0 0 ________ $ __________ Orange Fanta (24-can case) $ 1 4 .0 0 ________ $ __________ Coffee Filters ( 5 0/p a c k ) $ 0. 7 5 ________ $ __________ Sprite (24-can case) $ 1 4 .0 0 ________ $ __________ Coffee Pot Brush $ 8 .0 0 ________ $ __________ Arrowhead Bottled Water ( 24 - b o t t l e c a s e ) $ 1 4 .0 0 ________ $ __________ Coffee Pot Cleaner ( 1 2 o z .