K - Kosher • H - Halal • C - Clear • D - Diabetic • R - Resealable • G - Gluten Free • S - Soy Free

Total Total Total

Order Form Sumter County Qtr. 1 2017 Package Program Ordering Dates: February 20 - March 21, 2017Please complete all info on reverse (print clearly).

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

DRINKS

Coffee, Cappuccino & Cocoa

Folger’s 4 oz. 100% Colombian Coffee K H R $6.25 / EA 10961

Folger’s 4 oz. Traditional Roast Coffee K H R $5.50 / EA 10963

Keefe 10 oz. French Vanilla Cappuccino $2.45 / EA 80002268

Keefe 3 oz. 100% Colombian Coffee K H C R $3.15 / EA 7022

Swiss Miss 4.38 oz. Hot Cocoa w/Marshmallows (6 Pk.)

$2.40 / BX 80001146

Drink Mixes

Hawaiian Punch .94 oz. SF Green Berry Rush Drink Mix (8 Pk.)

$2.10 / BX 7178

Hawaiian Punch 0.91 oz. Singles To Go Berry Blue Typhoon (8 Pk.) G S

$2.10 / BX 7809

Jolly Rancher 0.57 oz. Singles To Go Cherry (6 Pk.) G S

$2.10 / PK 80000723

Sweet Fusions 12 oz. Watermelon Strawberry Drink Mix R

$2.15 / EA 10924

Wyler’s Light .80 oz. SF Singles To Go Strawberry Lemonade Drink Mix (8 Pk.) K

$4.30 / BX 80001731

Wyler’s SF .89 oz. Singles To Go Raspberry Drink Mix (8 Pk.)

$2.10 / BX 10733

FOOD & SNACKS

Cereal & Cereal Bar

Golden Valley 1.3 oz. Strawberry Cereal Bar K $0.40 / EA 6045

Kellogg’s 1.5 oz. Froot Loops Cereal (Single Serve) K

$1.00 / EA 10954

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Kellogg’s 12.2 oz. Apple Jacks Cereal K C R $5.00 / EA 10809

Quaker 15.1 oz. Maple Brown Sugar Instant Oatmeal (10 Pk.)

$5.55 / BX 5518

Sweet Home Farm 12 oz. French Vanilla Granola K $4.85 / EA 80001215

Pastries & Snack Cakes

JJ’s Tid-Bits 2 oz. Mini Snack Pie - Apple (6 Pk.) $3.95 / BX 80002090

JJ’s Tid-Bits 2 oz. Mini Snack Pie - Cherry (6 Pk.) $3.95 / BX 80002081

Kellogg’s 14.1 oz. Cinnamon Roll Pop Tarts (8 Pk.) $3.50 / BX 80002282

Kellogg’s 14.7 oz. Frosted Blueberry Pop Tarts (8 Pk.)

$3.75 / BX 10548

Market Square Bakery 4.75 oz. Chocolate Iced Honey Bun K C

$0.80 / EA 6540

Market Square Bakery 4 oz. Iced Swirl Cinnamon Roll K C

$1.15 / EA 6057

Market Square Bakery 4 oz. Strawberry ZuZus (2 Pk. Donuts) K

$1.05 / EA 6046

Mrs. Freshley’s 4.5 oz. Apple Fruit Pie $1.15 / EA 9739

Otis Spunkmeyer 3.5 oz. Marble Loaf Cake K $1.05 / EA 80003171

Otis Spunkmeyer 4 oz. Lemon Loaf Cake with Lemon Icing K

$1.05 / EA 80003169

Chips

“The Whole Shabang” 6 oz. Original Potato Chips K H

$2.30 / EA 5114

“The Whole Shabang” 9.5 oz. Extreme Crunchies K H

$2.75 / EA 80001670

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Cactus Annie’s 11 oz. “The Whole Enchilada” Party Mix K H C

$2.75 / EA 902

Cheetos 8 oz. Flamin’ Hot Crunchy C G $2.80 / EA 7687

Cheetos 9 oz. Crunchy C G $2.95 / EA 7683

Doritos 8 oz. Nacho Cheese Chips C $2.90 / EA 10514

Fritos 4 oz. Regular Corn Chips $1.55 / EA 6378

Lays 5.5 oz. Mesquite BBQ Stax Potato Chips $3.05 / EA 80003227

Lays 5.5 oz. Sour Cream & Onion Stax Potato Chips K G

$3.05 / EA 80003228

Moon Lodge 1.5 oz. Buffalo Wing Blue Cheese Potato Chips K

$0.65 / EA 80000963

Snacks & Nuts

“The Whole Shabang” 5 oz. Popcorn K H G $1.50 / EA 80002294

Combos 6.3 oz. Pepperoni Pizza H G S $3.80 / EA 6905

Cracker Jack 4 oz. Popcorn $1.50 / EA 80003277

Fiddle Faddle 6 oz. Butter Toffee Popcorn with Peanuts K

$2.00 / EA 6607

Good Sense 8 oz. Chipotle BBQ Mix C R $5.35 / EA 7864

Hormel 7.5 oz. Snackers Bacon & Jalapeno Dip G S

$5.75 / EA 80002277

Hormel 7.5 oz. Snackers Spinach Artichoke Dip G S $5.75 / EA 80002276

Kar’s 6 oz. Sweet ‘N Spicy Mix C $2.85 / EA 9674

Keebler .952 oz. Gripz Chocolate Chip Grahams $0.75 / EA 80002334

K - Kosher • H - Halal • C - Clear • D - Diabetic • R - Resealable • G - Gluten Free • S - Soy Free

Total Total Total

Order Form Sumter County Qtr. 1 2017 Package Program Ordering Dates: February 20 - March 21, 2017Please complete all info on reverse (print clearly).

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Keebler 1 oz. Chocolate Elf Grahams $0.75 / EA 80002332

Kellogg’s 1.3 oz. Original Rice Krispies Treats $1.00 / EA 2381

Kellogg’s 1.76 oz. Crunchmania Cinnamon Bun $0.85 / EA 80002330

Kellogg’s 1.76 oz. Crunchmania French Toast $0.70 / EA 80002331

Kellogg’s 3 oz. Rice Krispies Treats Double Choco-latey Chunk

$2.10 / EA 10572

Kings Nut 3 oz. Roasted & Salted Peanuts $0.95 / EA 80003354

Kings Nut 3 oz. Roasted Unsalted Peanuts $1.00 / EA 80003355

Snyder’s 2.25 oz. Honey Mustard and Onion Pretzel Pieces

$1.25 / EA 9553

Crackers

Austin 1.38 oz. Grilled Cheese on Saltines (8 Pk.) K $3.25 / BX 80000109

Austin 1.38 oz. Pepperjack on Saltines (8 Pk.) K $3.25 / BX 80000110

Cheez-It 1.5 oz. Cheddar Crackers K $0.60 / EA 9590

Cheez-It 7 oz. Cheddar Jack Crackers R $4.00 / EA 7452

Wheat Thins 1.75 oz. Crackers $0.75 / EA 9461

Cookies

Bud’s Best 6 oz. Candy ‘n Cookies - Butterfinger Mini Cookies K G S

$1.75 / EA 6386

Bud’s Best 6 oz. Chocolate Peanut Butter Mini Cookies K

$1.75 / EA 6384

Bud’s Best 6 oz. Orange Bite Delight Cookies $1.80 / EA 7924

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Checkers 8 oz. Raspberry Shortbread Cookies $2.35 / EA 7314

Delicious Bakery 12.4 oz. Chocolate Chip Cookies w/Candy Gems

$4.50 / EA 80001496

Famous Amos 2 oz. Chocolate Chip Cookies $0.60 / EA 850

Keebler 11.6 oz. Chips Deluxe Triple Chocolate Cookies K

$6.35 / EA 80000616

Lil Dutch Maid 5 oz. Duplex Creme Cookies $2.15 / EA 80002230

Market Square Bakery 6 oz. Chocolate Chip Cookies K H

$1.20 / EA 6072

Oven Baked 13 oz. Fudge Striped Shortbread Cookies

$3.00 / EA 80001120

Oven Baked 9.4 oz. Crispy Fudge Mint Cookies K C $2.90 / EA 6580

Candy

Atkinson’s 3.75 oz. Sugar Free Chick-O-Stick K G S $2.50 / EA 9765

Bit-O-Honey 4.2 oz. Bag $2.25 / EA 80000736

Chewy Lemonhead 4 oz. - Redrific $1.00 / EA 80000871

Cinamo Candy Stick .7 oz (10 Pk.) $2.60 / KIT 80002888

GoLightly 2.75 oz. Sugar Free Starlight Mints K C G $2.50 / EA 6330

GoLightly 2.75 oz. Sugar Free Vanilla Caramels K C $2.65 / EA 6331

Hot Tamales 5 oz. Candy Bag $2.25 / EA 80002269

Jolly Rancher 10 oz. Assorted Soft Chews $6.65 / EA 80002238

M&M’s 1.48 oz Mega Candies $0.65 / EA 80002242

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Old Dominion 6 oz. Peanut Brittle $2.80 / EA 80003030

Rainbow Candy (10 Pk.) $2.60 / KIT 80003433

Red Hots 4 oz. Cinnamon Flavored Hard Candy $1.00 / EA 80000869

Sathers 4 oz. Gummy Bears $1.00 / EA 80000867

Sathers 4 oz. Sour Neon Worms $1.00 / EA 80000868

Sathers 7.5 oz. Butterscotch Discs $1.40 / EA 40666

Select Sweets 8 oz. Jelly Beans $1.75 / EA 80002185

Starburst 2.07 oz. Fruit Chews $1.75 / EA 953

Werther’s 5.5 oz Candy $3.95 / EA 603

Zachary 5 oz. Double Dipped Chocolate Peanuts $2.35 / EA 3975

Pickle

Van Holten’s 9.6 oz. Dill Pickle K G S $0.80 / EA 381

Cheese

Cactus Annie’s 2 oz. Jalapeno Cheese Squeeze Snack G

$0.40 / EA 2585

City Cow 4 oz. Mozzarella Cheese Stick C G $1.85 / EA 5645

City Cow 4 oz. White Queso Dip C R G $1.85 / EA 6017

Painted Cow 2 oz. Dippins Cream Cheese C G $1.00 / EA 9655

Philly 2 oz. Cream Cheese w/Jalapenos $1.00 / EA 10911

Velveeta 2 oz. Sharp Cheddar Spread G $0.65 / EA 7739

K - Kosher • H - Halal • C - Clear • D - Diabetic • R - Resealable • G - Gluten Free • S - Soy Free

Total Total Total

Order Form Sumter County Qtr. 1 2017 Package Program Ordering Dates: February 20 - March 21, 2017Please complete all info on reverse (print clearly).

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Velveeta 4 oz. Nacho Cheese Dip w/Jalapenos Snack Spread Tub C R G

$1.60 / EA 9398

Velveeta 8 oz. Spicy Jalapeno Cheese Snack Spread Tub C R G

$2.30 / EA 9397

Meat Snacks

Brookfield Farms 2.1 oz. Fully Cooked Hickory Bacon (15 slices)

$5.70 / EA 5885

Brushy Creek 1.6 oz. Regular Summer Sausage $1.65 / EA 80001715

Brushy Creek 5 oz. Beef & Chicken Hot Sau-sage H G

$3.20 / EA 80003317

Brushy Creek 5 oz. Beef & Chicken Sausage H G $3.20 / EA 80003316

Brushy Creek 5 oz. Beef Salami Stick G S $3.20 / EA 80001739

Carmela 10 oz. Vienna Sausage Bites $2.40 / EA 80001054

Jack Link’s 4 oz. Deli Cuts Sausage Bites $5.40 / EA 6354

O’Brien’s 1.125 oz. Beef Sticks Hickory Smoked G $1.25 / EA 5379

O’Brien’s Double Barrel 1.125 oz. Spicy Meat & Jalapeno Cheese

$1.15 / EA 80001205

Seafood

Bumble Bee 5 oz. Tuna in Pouch K $4.00 / EA 9768

Chicken of the Sea 3.53 oz. Sardines in Louisiana Hot Sauce K

$2.00 / EA 10358

Chicken of the Sea 5 oz. Pink Salmon K $4.00 / EA 4179

Fresh Catch 3.53 oz. Fillets of Mackerel in Soybean Oil K H G

$1.95 / EA 4385

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Fresh Catch 3.53 oz. Yellowfin Tuna Steak in Spicy Thai Chili Sauce K H G

$4.00 / EA 5696

Fresh Catch 4.23 oz. Chunk Light Tuna in Water K H G

$2.50 / EA 4317

Starkist 3 oz. Ready-to-Eat Tuna Salad $4.95 / EA 10705

Ready-To-Eat Meals

Brushy Creek 11.25 oz. Beef Stew G $2.50 / EA 1715

Brushy Creek 11.25 oz. Chili with Beans G $2.40 / EA 1711

Brushy Creek 11.25 oz. Hot Chili with Beans (HOT) G

$2.20 / EA 1712

Brushy Creek 11.25 oz. Lasagna with Beef $2.00 / EA 1721

Brushy Creek 11.25 oz. Low Fat Spicy Chili w/Beans $2.75 / EA 10274

Brushy Creek 11.25 oz. Sloppy Joe Sauce with Beef $3.65 / EA 1723

Brushy Creek 5 oz. Chicken Vienna Sausage G S $1.75 / EA 80002944

Brushy Creek 5 oz. Spicy Chicken Vienna Sausage $1.75 / EA 80002945

Brushy Creek 7 oz. Chunk Ham with Natural Juices $4.30 / EA 80002117

Brushy Creek 8 oz. Southwestern Style Black Beans and Beef

$3.10 / EA 80000266

Brushy Creek 8 oz. Chicken Chili w/White Beans $2.50 / EA 80001465

Brushy Creek 8 oz. Mexican Style Chicken Stew G $3.30 / EA 80003085

Rice & Beans

Brushy Creek 10 oz. Black Beans G $1.90 / EA 4915

ITEM DESCRIPTION PRICE ITEM # QTY TOTALPRICE

Brushy Creek 10 oz. Seasoned Pinto Beans in Sauce $2.10 / EA 80002106

Sevilla 4.4 oz. HOT Chili Flavor Refried Beans & Rice K H C

$1.30 / EA 5940

Velveeta 4 oz. Spicy, Cheesy Refried Beans & Rice K H C

$1.50 / EA 4941

Zatarain’s 8.8 oz. Big Easy Rice - Jambalaya $3.95 / EA 10453

Tortillas

Chi-Chi’s 9 oz. White Corn Tortillas (10 Pk.) K C G $1.55 / EA 6190

Nuevo Leon 13 oz. 8 inch Flour Tortillas (10 Pk.) $1.55 / EA 80002202

Ramen

Maruchan 3 oz. Cajun Chicken Flavor Ramen C $0.45 / EA 18

Maruchan 3 oz. Chili Flavor Ramen C $0.45 / EA 10

Maruchan 3 oz. Texas Beef Flavor Ramen C $0.45 / EA 13

Noodles

Barilla 16 oz. Angel Hair Pasta $3.65 / EA 9429

Cinch 7.25 oz. Macaroni & Cheese $1.05 / EA 764

Inmate’s Name ID#

Institution/Dorm/Housing#

Street Address

City State Zip

Sender’s Name

Street Address

City State Zip

Phone Number

Email (You will receive confirmation emails when the order is shipped and received.)

SHIP TO:

SENDER:

We cannot send orders from one inmate to another.

REQUIRED for order fulfillment.

CALCULATE AMOUNT DUE:TAX TOTALS

Food Items Total: x 1.04 =

Processing Fee: $2.95 x 1.04 = $3.07

TOTAL AMOUNT DUE:

Credit Card Number

/

Expiration Date Security Code

Security code is last three digits of account number panel.

SELECT PAYMENT METHOD:

¨ Cashier’s Check ¨ Money OrderMake check or money order payable to ACCESS SECUREPAK

¨ VISA ¨ MasterCard ¨ Discover

Cardholder Name

Cardholder Signature

Daytime Phone Number Today’s Date mm/dd/yyyy/ /

Order Form Sumter County Qtr. 1 2017 Package Program Ordering Dates: February 20 - March 21, 2017Please complete all info on reverse (print clearly).

PROGRAM DATES:Ordering Begins: February 20, 2017Ordering Ends: March 21, 2017Postmark date for mail orders: March 14, 2017 Orders must be received by: March 21, 2017Delivery to facility: On or before April 1, 2017

WAYS TO ORDER Online: sumtercountypackages.comPhone: 1-855-768-0785Mail: Access Securepak (GA), 10880 Linpage Place St. Louis, MO 63132

ACCEPTABLE FORMS OF PAYMENT: • Credit/Debit Cards—VISA, MasterCard, Discover• Prepaid cards that have a verifiable United States address• Cashier’s check• Money orderWe do not accept personal checks and will return them to the send-er. Credit/debit and prepaid cards will be charged on the day the order is placed. Refunds or credits will be applied to the card used for the order (allow additional time for refunds/credits on prepaid cards). Access Securepak reserves the right to remove one or more items from the order due to insufficient payment.

SALES TAX: Access Securepak is required by the state of Georgia to collect sales tax on all merchandise including the processing fee. Please see the tax calculation example below for more information.

Tax calculation example: $87.52 merchandise total x 1.04 (tax rate) = $91.02 merchandise subtotal$2.95 processing fee x 1.04 (tax rate) = $3.07 processing fee sub-total$91.02 merchandise subtotal + $3.07 processing fee subtotal = $94.09 total due

ELIGIBILITY: Access Securepak verifies inmate eligibility before shipping packages, if applicable.

LIMITS: Maximum $100 or 15 lbs. of product per inmate (whichev-er is reached first). Multiple packages can be ordered, and we will consolidate orders not to exceed the maximum $100 or 15 lbs. of product per program.

CATALOG CHANGES: Every effort has been made to show and describe the merchandise as accurately as possible. Because many manufacturers change an item’s design, color, package size and style after our catalog is produced, we reserve the right to discontin-ue or change product specifications without prior notice. We regret any changes that might occur and will make every effort to minimize these occurrences. Inadvertent errors in product descriptions, pricing and special offers are not binding on Access Securepak, and we may make adjustments at any time. Additionally, many of our food items may contain common allergens such as milk, eggs, wheat and peanuts. Before consuming a food item, please consult the product packaging for specific information on its ingredients. Prices and offers are subject to change and available while supplies last. Always consult the sumtercountypackages.com website for the latest updates on this package program.

In the event of a back order, may we substitute like items of equal or greater value? Note: unless you choose “NO,” we may substitute for out-of-stock or restricted items. _YES _NO

CUSTOMER SERVICE:sumtercountypackages.comAutomated system is available 24 hours a day, seven days a week1-855-768-0785 Live bilingual representatives are available Monday through Friday, 8:30 a.m.–11:59 p.m. EST, and Saturday, 11 a.m.–5 p.m. EST.