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

Total Total

Order Form Piedmont Regional Jail Effective March 2018Please complete all info on reverse (print clearly).

ITEM DESCRIPTION PRICE ITEM # Size QTY TOTALPRICE

DRINKS

Coffee & Cappuccino

Hostess 6.75 oz. Twinkie Cappuccino $2.30 / EA 80005756

Nescafe 4 oz. Clasico Pouch K C R G S $6.30 / EA 7588

Sweetener

Splenda .035 oz. Single Serve Pack G S $0.10 / EA 6467

Drink Mixes

Crystal Light 1.12 oz. SF Variety Pack Drink Mixes (10 Ct.) $6.75 / KIT 42117

Hawaiian Punch .94 oz. Singles To Go Sugar Free Orange Ocean (8 Pk.)

$4.00 / BX 7812

Nutritional Drinks

New Leaf 2 oz. Chocolate Health Shake K $1.50 / EA 80003592

New Leaf 2 oz. Vanilla Health Shake $1.50 / EA 80003593

FOOD & SNACKS

Cereal

Cap’n Crunch 16.1 oz. Cereal $5.90 / EA 80006092

Kellogg’s 3.1 oz. Froot Loops Cereal K R $2.15 / EA 80005257

Kellogg’s 3.6 oz. Frosted Flakes Cereal K R $2.15 / EA 80005254

Pastries & Snack Cakes

Hostess 11.25 oz. Chocolate Frosted Mini Donuts $4.65 / EA 80003703

Hostess 5 oz. Berries & Cream Cheese Danish $2.25 / EA 80002460

Kellogg’s 14 oz. Frosted Brown Sugar Cinnamon Pop Tarts (8 Pk.)

$4.00 / BX 10549

Mrs. Freshley’s 3.5 oz. Carrot Cake C $1.40 / EA 7218

Nature Valley 8.9 oz. Oats ‘n Honey Granola Bars (12 Pk.) K $7.95 / BX 7167

Chips

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

Cheetos 9 oz. Crunchy C G $3.05 / EA 7683

ITEM DESCRIPTION PRICE ITEM # Size QTY TOTALPRICE

Doritos 8 oz. Nacho Cheese Chips C $2.65 / EA 10514

Jones’ 9 oz. Sweet Honey BBQ Potato Chips $4.30 / EA 80005925

Jones’ 9 oz. Wavy Salt & Vinegar Flavored Potato Chips $4.30 / EA 80005926

Moon Lodge 6 oz. Sour Cream & Onion Potato Chips K H G $3.50 / EA 5113

The Whole Shabang 6 oz. Original Potato Chips K H $3.50 / EA 5114

Snacks & Nuts

Combos 6.3 oz. Pepperoni Pizza H G S $4.45 / EA 6905

Fiddle Faddle 6 oz. Caramel Popcorn w/Peanuts K $2.40 / EA 6606

Kar’s 7 oz. Nut ‘N Yogurt Trail Mix C $3.25 / EA 9811

Kellogg’s 3 oz. Rice Krispies Treats Double Chocolatey Chunk $2.25 / EA 10572

Kings Nut 3.25 oz. Roasted & Salted Sunflower Kernels K H G S

$0.90 / EA 80003356

Snyder’s 2.25 oz. Honey Mustard and Onion Pretzel Pieces $1.15 / EA 9553

Crackers

Cheez-It 2 oz. White Cheddar Crackers $1.15 / EA 10706

Cheez-It 7 oz. Cheddar Jack Crackers R $5.25 / EA 7452

Golden Valley 9 oz. Cheese Crackers K G S $3.50 / EA 718

Wheat Thins 1.75 oz. Crackers $0.85 / EA 9461

Cookies

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

$1.95 / EA 6386

Bud’s Best 6 oz. Peanut Butter ‘n Graham Cookies $1.95 / EA 10352

Market Square Bakery 2.75 oz. Soft Baked Oatmeal Raisin Cookies (2 Pk.) K

$0.80 / EA 7648

Otis Spunkmeyer 4 oz. Chocolate Chunk Cookie $1.35 / EA 80005563

Candy

Atkinson’s 3.75 oz. Sugar Free Crunchy Peanut Butter Bars K C $3.00 / EA 9764

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

Total Total

Order Form Piedmont Regional Jail Effective March 2018Please complete all info on reverse (print clearly).

ITEM DESCRIPTION PRICE ITEM # Size QTY TOTALPRICE

GoLightly 2.75 oz. Sugar Free Butterscotch Candy K C G $3.00 / EA 6329

GoLightly 2.75 oz. Sugar Free Starlight Mints K C G $3.00 / EA 6330

GoLightly 2.75 oz. Sugar Free Vanilla Caramels K C $3.00 / EA 6331

Malley’s 1.75 oz. Pretzel Crunch Bar $3.10 / EA 80005928

Mayfair Select Sweets 5 oz. Caramel Creams C $2.05 / EA 10347

Mayfair Select Sweets 6.5 oz. Peach Rings C $2.05 / EA 10345

Milk Chocolate .3 oz. Peanut Chews (6 Pk.) $1.00 / KIT 80000653

Snickers 4.4 oz. Miniatures K $3.70 / EA 6090

Zachary 5.5 oz. Thin Mints $2.60 / EA 5234

Cheese

Cactus Annie’s 2 oz. Jalapeno Cheese Squeeze Snack G $0.95 / EA 2585

City Cow 4 oz. Mozzarella Cheese Stick C G $2.15 / EA 5645

Meat Snacks

Brookfield Farms 2.1 oz. Fully Cooked Hickory Bacon (15 slices) $6.75 / EA 5885

Brushy Creek 5 oz. Beef Salami Stick G S $3.25 / EA 80001739

Jack Link’s 2.4 oz. Screamin’ Demon HOT! Pickled Sausage C $2.55 / EA 3257

Seafood

Chicken of the Sea 3.53 oz. Sardines in Louisiana Hot Sauce K $2.25 / EA 10358

Chicken of the Sea 5 oz. Light Tuna in Water K $4.75 / EA 10337

Chicken of the Sea 5 oz. Pink Salmon K $4.75 / EA 4179

Fresh Catch 3.53 oz. Chuck Light Tuna w/Jalapenos $3.15 / EA 80005516

Fresh Catch 3.53 oz. Fillets of Mackerel in Soybean Oil K H G $2.25 / EA 4385

Fresh Catch 3.53 oz. Fish Steaks in Louisiana Hot Sauce K H G $2.25 / EA 4397

Ready-To-Eat Meals

Brushy Creek 10 oz. Roast Beef and Gravy $6.25 / EA 7620

ITEM DESCRIPTION PRICE ITEM # Size QTY TOTALPRICE

Brushy Creek 11.25 oz. Chili with Beans Hot! G $2.40 / EA 1712

Brushy Creek 11.25 oz. Low Fat Spicy Chili w/Beans $2.95 / EA 10274

Brushy Creek 5 oz. Pulled Chicken in Buffalo Style Sauce G $4.90 / EA 6476

Rip ‘N’ Ready 10 oz. Meatballs H $5.50 / EA 3971

Rice & Beans

Brushy Creek 10 oz. Black Beans G $2.15 / EA 4915

Keefe Kitchens 6.5 oz. Pre-Cooked Long Grain Brown Rice K C R G S

$2.05 / EA 7525

Minute 8 oz. White Rice Clear Pouch $1.60 / EA 80005364

Velveeta 4 oz. Spicy, Cheesy Refried Beans K H C $1.75 / EA 4940

Velveeta 4 oz. Spicy, Cheesy Refried Beans & Rice K H C $1.75 / EA 4941

Zatarain’s 8.8 oz. Big Easy Rice - Jambalaya $5.05 / EA 10453

Ramen

Maruchan 3 oz. Chili Flavor Ramen C $1.00 / EA 10

Maruchan 3 oz. Hot & Spicy Vegetable Flavor Ramen C $1.00 / EA 505

Noodles

Knorr Lipton 4.4 oz. Italian Sides Creamy Garlic Shells H G S $3.85 / EA 7125

HEALTH & BEAUTY

Hair Care

5” Black Comb $0.05 / EA 80000112

Military Style Brush $2.45 / EA 80001297

Pert Plus 13.5 oz. 2 in 1 Shampoo with Conditioner $8.10 / EA 22993

Suave 2 in 1 - 12.6 oz. Shampoo and Conditioner $5.65 / EA 24869

Vent Hair Brush $1.00 / EA 20282

Body Wash

Suave 15 oz. Everlasting Sunshine Body Wash $5.55 / EA 80004576

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

Total Total

Order Form Piedmont Regional Jail Effective March 2018Please complete all info on reverse (print clearly).

ITEM DESCRIPTION PRICE ITEM # Size QTY TOTALPRICE

Soap

Dial 4 oz. Gold Soap (1 Bar) $1.85 / EA 20925

Lever 2000 3.15 oz. Original Soap (1 Bar) $2.20 / EA 80005837

Skin Care

Chapstick .15 oz. Classic Lip Balm $3.20 / EA 20513

Infuzed Island Naturals 15 oz. Coconut Lime & Aloe Lotion $3.00 / EA 24967

Infuzed Island Naturals 15 oz. Shea Butter Lotion $3.00 / EA 24966

Suave 10 oz. Cocoa Butter with Shea Lotion $5.55 / EA 21924

Deodorant

Speed Stick 3 oz. Ultimate Sport Anti-Perspirant/Deodorant Gel C

$5.45 / EA 21126

Dental Care

Aim 5.5 oz. Multi-Benefit Tartar Control Cool Mint Gel Tooth-paste

$2.90 / EA 80002950

Close-Up 4 oz. Regular Gel Toothpaste $3.05 / EA 20104

Colgate Classic Soft Toothbrush $1.45 / EA 80002159

Pharmaceuticals

Halls Cherry Flavored Cough Drops (9 Ct.) $1.85 / EA 20244

CLOTHING & APPAREL

T-Shirts

Andrew Scott Select Crewneck T-Shirt - White (1 Pk.) Small, Medium, Large, XL, 2XL, 3XL

$4.45 / EA 53185-01______

Men’s Underwear

Andrew Scott Men’s Boxers - White (1 Pk.) Small, Medium, Large, XL

$3.95 / EA 51602-01______

Andrew Scott Men’s Boxers - White (1 Pk.) 2XL $4.85 / EA 51602-01 ______

Andrew Scott Men’s Boxers - White (1 Pk.) 3XL $5.85 / EA 51602-01 ______

Andrew Scott Men’s Briefs - White (1 Pk.) Small, Medium, Large, XL

$2.99 / EA 51603-01______

Andrew Scott Men’s Briefs - White (1 Pk.) 2XL, 3XL $4.15 / EA 51603-01 ______

ITEM DESCRIPTION PRICE ITEM # Size QTY TOTALPRICE

Women’s Underwear

Hanes Her Way Cotton Briefs - White (3 Pk.) 6, 7, 8, 9, 10, 11, 12

$9.75 / PK 50691-01______

Thermals

Indera Mills Thermal Ankle-Length Drawers - Natural Small, Medium, Large, XL

$6.45 / EA 50544-99______

Indera Mills Thermal Ankle-Length Drawers - Natural 2XL, 3XL $8.05 / EA 50544-99 ______

Indera Mills Thermal Ankle-Length Drawers - Natural 4XL, 5XL $9.95 / EA 50544-99 ______

Indera Mills Thermal Long Sleeve Shirt - Natural Small, Medium, Large, XL

$6.45 / EA 50543-99______

Indera Mills Thermal Long Sleeve Shirt - Natural 2XL, 3XL $8.05 / EA 50543-99 ______

Indera Mills Thermal Long Sleeve Shirt - Natural 4XL, 5XL, 6XL $9.95 / EA 50543-99 ______

MISCELLANEOUS

Games

Bicycle Playing Cards $4.60 / EA 20210

UNO Cards $13.20 / EA 32099

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 placed and shipped)

SHIP TO:

SENDER:

We cannot send orders from one inmate to another.

REQUIRED for order fulfillment.

PROGRAM DATES:

Ordering Begins: March 5, 2018

Delivery to facility: Weekly

WAYS TO ORDER:

Online: piedmontpackages.com

Phone: 1.800.546.6283

Mail: Access Securepak (VA)

10880 Linpage Place

St. Louis, MO 63132

Fax: 1.866.754.2813

ACCEPTABLE FORMS OF PAYMENT:

• Credit/Debit Cards—VISA, MasterCard, Discover

• Prepaid cards that have a verifiable United States address

• Cashier’s check

• Money order

We 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 Virginia

to collect 2.5% sales tax on food and 5.3% sales tax on non-food

items and processing fees.

Tax calculation example:

$35.25 food total x 1.025 (tax rate) = $36.13 food subtotal

$20.85 non- food total x 1.053 (tax rate) = $21.96 non- food subtotal

$5.95 processing fee x 1.053 (tax rate) = $6.27 processing fee

subtotal

$36.13 food subtotal + $21.96 non- food subtotal + $6.27 process-

ing fee subtotal = $64.36 total amount due

ELIGIBILITY: Access Securepak verifies inmate eligibility before ship-

ping packages, if applicable.

LIMITS: Maximum $100.00 of product per week, per inmate. Multiple

packages can be ordered, and we will consolidate orders not to

exceed the maximum $100.00 of product per program.

CATALOG CHANGES: Every effort has been made to show and describe

the merchandise as accurately as possible. Because many man-

ufacturers change an item’s design, color, package size and style

after our catalog is produced, we reserve the right to discontinue 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, pric-

ing 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 of-

fers are subject to change and available while supplies last. Always

consult the piedmontpackages.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:

piedmontpackages.com

Automated system is available 24 hours a day, seven days a week

1-800-546-6283

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.

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 ¨ Prepaid

Cardholder Name

Cardholder Signature

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

Order Form Piedmont Regional Jail Effective March 2018Please complete all info on reverse (print clearly).

CALCULATE AMOUNT DUE:TAX TOTALS

Food Items: x 1.025 =

Non-Food Items: x 1.053 =

Processing Fee $5.95 x 1.0530 = $6.27

TOTAL AMOUNT DUE: