Boaters for a Cure

Personal Information
Name:
Address: City/State: Zip Code:
Your Dinner Order
Chicken Paprikash Number of Dinners _____ X $25.00 = _____	Lasagna with Meat Number of Dinners _____ X $25.00 = _____
Beef Brisket Number of Dinners_____ X $25.00 = _____	Lasagna without Meat Number of Dinners _____ X $25.00 = _____

Payment Information
Check Number________	Total Amount Due $___________

Print this order form and fill in your information. Send your check and this order form to:

If you have any questions you can call us at (440) 255-4170 or e-mail us at
info@boatersforacure.com