Name: __________________________________________

Student’s Name: ___________________________________

School: __________________________________________

Number of Tickets Requested: __________________________

Amount Enclosed: $__________________________________

All school tickets come 35 tickets to a sheet for $105.00.

Individual ticket as follows: Lunch $3.00 Breakfast $2.00 Milk Tickets $ .50

Please make a check payable to Lexington School Lunch.(CHECKS ONLY, NO CASH)

Mail requests to:

Chartwell's

C/O LHS

251 Waltham St.

Lexington, MA 02421

Please include a business sized self-addressed stamped envelope.