| A | B | C | D | E | F | G | H | I | J | K | L | |
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2 | MIDSUN SCHOOL EDUCATION ENHANCEMENT SOCIETY | |||||||||||
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4 | GROCERY GIFT CARD ORDER FORM | |||||||||||
5 | JANUARY/FEBRUARY/MARCH 2012 | |||||||||||
6 | ||||||||||||
7 | ORDERS FOR JANUARY 2012 CARDS MUST BE IN BY January 16, 2012 | |||||||||||
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9 | NAME: | PHONE (cell): | ||||||||||
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11 | PHONE: | EMAIL: | ||||||||||
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15 | JANUARY 2012 | |||||||||||
16 | ||||||||||||
17 | SAFEWAY | CO-OP | SOBEYS | SUPERSTORE | ||||||||
18 | _____ x $50= | $________ | _____ x | $50 = | $________ | _____ x | $50 = | $________ | _____ x | $50 = | $________ | |
19 | _____ x $100= | $________ | _____ x | $100 = | $________ | _____ x | $100 = | $________ | _____ x | $100 = | $________ | |
20 | _____ x $200= | $________ | _____ x | $200 = | $________ | _____ x | $200 = | $________ | _____ x | $200 = | $________ | |
21 | TOTAL | $________ | TOTAL | $________ | TOTAL | $________ | TOTAL | $________ | ||||
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23 | JANUARY 2012 - TOTAL $ _______________________ | |||||||||||
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25 | ||||||||||||
26 | FEBRUARY 2012 | |||||||||||
27 | ||||||||||||
28 | SAFEWAY | CO-OP | SOBEYS | SUPERSTORE | ||||||||
29 | _____ x $50= | $________ | _____ x | $50 = | $________ | _____ x | $50 = | $________ | _____ x | $50 = | $________ | |
30 | _____ x $100= | $________ | _____ x | $100 = | $________ | _____ x | $100 = | $________ | _____ x | $100 = | $________ | |
31 | _____ x $200= | $________ | _____ x | $200 = | $________ | _____ x | $200 = | $________ | _____ x | $200 = | $________ | |
32 | TOTAL | $________ | TOTAL | $________ | TOTAL | $________ | TOTAL | $________ | ||||
33 | ||||||||||||
34 | FEBRUARY 2012 - TOTAL $ _______________________ | |||||||||||
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36 | ||||||||||||
37 | MARCH 2012 | |||||||||||
38 | ||||||||||||
39 | SAFEWAY | CO-OP | SOBEYS | SUPERSTORE | ||||||||
40 | _____ x $50= | $________ | _____ x | $50 = | $________ | _____ x | $50 = | $________ | _____ x | $50 = | $________ | |
41 | _____ x $100= | $________ | _____ x | $100 = | $________ | _____ x | $100 = | $________ | _____ x | $100 = | $________ | |
42 | _____ x $200= | $________ | _____ x | $200 = | $________ | _____ x | $200 = | $________ | _____ x | $200 = | $________ | |
43 | TOTAL | $________ | TOTAL | $________ | TOTAL | $________ | TOTAL | $________ | ||||
44 | ||||||||||||
45 | MARCH 2012 - TOTAL $ _______________________ | |||||||||||
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49 | Payments can be made by either CASH or CHEQUE (NO CREDIT CARDS AT THIS TIME) | |||||||||||
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51 | ||||||||||||
52 | Please indicate if you would be interested in using a credit card in the future (MASTERCARD or VISA): | |||||||||||
53 | _____ Yes | _____ No | ||||||||||
54 | ||||||||||||
55 | Please POST DATE CHEQUES FOR | NSF cheques will be charged a $25 service fee | ||||||||||
56 | January 16th, February 15th , March 15th | and grocery cards will not be issued until further | ||||||||||
57 | payment is received. | |||||||||||
58 | Make all cheques payable to: | |||||||||||
59 | MIDSUN SCHOOL EDUCATION ENHANCEMENT SOCIETY | |||||||||||
60 | ||||||||||||
61 | You will be notified via email that the cards are available for pickup at the office. A signature will be | |||||||||||
62 | required at that time. | |||||||||||