Daily Purchase Limit Request Form

Student Name:_______________________________

Building:____________________________________

 Please check the options you wish to activate:

_______________No ala carte purchases
_______________Daily sales purchases not to exceed (amount) $ __________
_______________No extra slice of pizza at Wylie

Note: Wylie., Creekside, Mill Creek and DHS will combine breakfast and lunch prices
for a daily total daily sale.

Parent Signature__________________________________________________________

Phone:____________________________________ Date ____________________________

This form is for use at Wylie, Creekside, Mill Creek and DHS only.

Limits placed on an account will remain in effect until you notify our office.

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