Grocery card order form
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MIDSUN SCHOOL EDUCATION ENHANCEMENT SOCIETY
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GROCERY GIFT CARD ORDER FORM
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JANUARY/FEBRUARY/MARCH 2012
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ORDERS FOR JANUARY 2012 CARDS MUST BE IN BY January 16, 2012
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NAME:PHONE (cell):
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PHONE:EMAIL:
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JANUARY 2012
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SAFEWAYCO-OPSOBEYSSUPERSTORE
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_____ x $50=$_____________ x $50 = $_____________ x $50 = $_____________ x $50 = $________
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_____ x $100=$_____________ x $100 = $_____________ x $100 = $_____________ x $100 = $________
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_____ x $200=$_____________ x $200 = $_____________ x $200 = $_____________ x $200 = $________
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TOTAL$________TOTAL$________TOTAL$________TOTAL$________
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JANUARY 2012 - TOTAL $ _______________________
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FEBRUARY 2012
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SAFEWAYCO-OPSOBEYSSUPERSTORE
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_____ x $50=$_____________ x $50 = $_____________ x $50 = $_____________ x $50 = $________
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_____ x $100=$_____________ x $100 = $_____________ x $100 = $_____________ x $100 = $________
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_____ x $200=$_____________ x $200 = $_____________ x $200 = $_____________ x $200 = $________
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TOTAL$________TOTAL$________TOTAL$________TOTAL$________
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FEBRUARY 2012 - TOTAL $ _______________________
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MARCH 2012
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SAFEWAYCO-OPSOBEYSSUPERSTORE
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_____ x $50=$_____________ x $50 = $_____________ x $50 = $_____________ x $50 = $________
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_____ x $100=$_____________ x $100 = $_____________ x $100 = $_____________ x $100 = $________
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_____ x $200=$_____________ x $200 = $_____________ x $200 = $_____________ x $200 = $________
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TOTAL$________TOTAL$________TOTAL$________TOTAL$________
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MARCH 2012 - TOTAL $ _______________________
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Payments can be made by either CASH or CHEQUE (NO CREDIT CARDS AT THIS TIME)
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Please indicate if you would be interested in using a credit card in the future (MASTERCARD or VISA):
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_____ Yes_____ No
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Please POST DATE CHEQUES FOR NSF cheques will be charged a $25 service fee
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January 16th, February 15th , March 15thand grocery cards will not be issued until further
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payment is received.
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Make all cheques payable to:
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MIDSUN SCHOOL EDUCATION ENHANCEMENT SOCIETY
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You will be notified via email that the cards are available for pickup at the office. A signature will be
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required at that time.
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Grocery Card Order Form
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