Return Form By: April 22

GIFT CARD ORDER FORM

Grocery Stores

Quantity $Total

(DB) Safeway 3%

$50.00
$100.00

(DB) IGA 5%

$25.00

(Extra Foods)

$50.00

Quantity

(DB) Aldo 7%

$25.00

(DB) American Eagle 5%

$25.00

(DB) Bath and Body Works 7%

$50.00

(DB) Real Canadian Superstore 3%

Specialty Stores

(DB) Best Buy 2%

$25.00
$25.00
$50.00

$100.00

$100.00

(DB) Canadian Tire 3%

$250.00

$25.00
$50.00
$100.00

(DB) Chapters/Indigo/Coles 10%

Restaurants
(DB) Boston Pizza 7%

Quantity $Total

(DB) Claries 9%
(DB) Future Shop 2%

$25.00
$50.00

(DB) Burger King 5%

$25.00
$25.00
$50.00

$10.00

$100.00

(DB) i-Tunes 5%

$25.00

(DB) Cactus Club 7%

$20.00

$25.00

$10.00
$25.00

$50.00

(DB) La Senza 7%

$25.00

(DB) Dominos 10%

$25.00

(DB) London Drugs 2%

$25.00

(DB) Earls 7%

$25.00

$50.00

$50.00

(DB) Keg 7%
(DB) Milestone's 3%

$100.00

(DB) Marks's Work Warehouse 7%

$25.00

$25.00

$50.00

$50.00

$25.00

$100.00

$50.00

(DB) M&M Meats 3%

(DB) Moxie's 10%

$25.00

(DB) Old Navy/The Gap 7%

(DB) Old Spaghetti Factory 5%

$25.00

(DB) Olive Garden 7%

$25.00

(DB) Payless Shoe Source 5%

(DB) Red Robin 7%

$25.00

(DB) Pet Smart 3%

$25.00

(DB) Starbucks 5%

$10.00

(DB) Shoppers Drup Mart 3%

$25.00

$25.00

$50.00

$50.00

(DB) Swiss Chalet 3%

$25.00
$50.00

$25.00

(DB) Subway 5%

$25.00

$10.00

(DB) Sports Check 4%

$25.00

(DB) Staples 3%

$25.00

$25.00

$50.00

$50.00

$100.00

$25.00

(DB) The Children's Place 7%

$25.00

$50.00

(DB) The Shoe Company 7%

(C) Triple O's 7%

$10.00

(DB) Toys R Us 2%

$25.00

(DB) Wendy's Restaurant 3%

$10.00

(DB) Winners/HomeSense 7%

$25.00

(DB) White Spot 7%

$25.00

Entertainment
(DB) Cineplex Odeon 5%

$50.00

Quantity $Total
$10.00
$25.00

$25.00

Gas

Quantity $Total

Department Stores

(C) Cheveron 2%

$25.00

(DB) HBC 3%

(DB) Esso 2%

$25.00

(Hudson Bay and Home Outfitters,

$25.00

$50.00

$50.00
$100.00

(DB) Sears 2%

$100.00

(DB) Petro-Canada 2%

Quantity

$25.00

$25.00

$50.00

$50.00

$100.00

$100.00

Attractions
Home Improvements
(DB) Home Depot 2%

(DB) Rona 3%

Quantity $Total

Quantity

Country Garden Ltd. 5%

$25.00

$25
$50.00

$50.00

Minter Gardens 2012 Season's Pass 5%

$100.00

Adult

$25.00

$25.00

Senior

$23.00

$50.00
$100.00

DB: Declining Balance Shopping Card

C: Change Back Shopping Certificate
CANNOT PAY OFF ACCOUNT WITH CARDS OR CERTIFICATES

GRAND TOTAL: $
Thanks for your support!

Name:
Phone:
PAYMENT INFORMATION:

Orders are payable by cash or cheque made out to Greendale PAC

Cheque # By indicating you would like your order sent home with your child, you agree to accept all responsbility
for lost or damaged cards/certificates.

Please send my order with ____________________ Teacher ___________

OR
I would like to pick up my order from the school ____________________
If ordering for other people and paying by cheque please indicate cheque numbers below:

$Total

$Total

$Total

RTIFICATES

dale PAC

nsbility