1425 JEFFERSON ROAD HENRIETTA, NY 14623 PHONE: 585-292-9630 FAX: 585-292-9804 (NEXT TO POST OFFICE)

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(CIRCLE ONE)

  Type - (SEEDED RYE, WHITE, WHOLE WHEAT, SOUR DOUGH OR A SMALL SUB ROLL  $7.99

   Type - (WHITE, WHEAT) $8.99

  Type - (white, wheat, sun dried tomato, spinach, garlic & herb, salsa

red roasted pepper, cheddar jalapeño) $8.99

(CIRCLE ONE)

  HOT HAM, TURKEY, TUNA, PASTRAMI, GENOA SALAMI, CAPPICOLA, CHICKEN BREAST, HAM, ROAST BEEF,

CORNED BEEF, BOLOGNA, CHICKEN SALAD, B.L.T., ASSORTED CHEESE OR CREATE YOUR OWN _____________

(CIRCLE ONE)

  MAYO, LITE MAYO, MUSTARD {YELLOW, BROWN, HONEY, SPICY}, ITALIAN DRESSING,

LITE VINAIGRETTE, THOUSAND ISLAND, HORSERADISH, LETTUCE, SPINACH, ROMAINE, TOMATO, ONION, CUCUMBER,

HOT PEPPERS, SWEET PEPPERS, PICKLES, BLACK OLIVES, GREEN OLIVES, JALAPENOS, GREEN PEPPERS.

(CIRCLE ONE)

(AMERICAN, SWISS, PROVOLONE, MOZZARELLA, COLBY, MUENSTER, PEPPER JACK, FETA)

(CIRCLE ONE)

(MACARONI, POTATO, COLESLAW OR PASTA SALAD)

(CIRCLE ONE)

(CHOCOLATE CHIP, PEANUT BUTTER, OATMEAL CRANBERRY, TURTLE OR STRAWBERRY SHORTCAKE)

(CIRCLE ONE)

(COKE, DIET COKE, DIET CAFFEINE FREE COKE, SPRITE, ROOT BEER, CANADA DRY, NESTEA, LEMONADE OR WATER)

YOUR NAME: __________________________              YOUR PHONE NUMBER:  ________________________