Created: 10/2/2016 2:19:28 PM

Family Order Form

Culbertson Elementary Parent Teacher Organization

2% - 20% of your order will go to our children's education at Culbertson. Send orders and payment in an envelope marked Tiger Mall.
Orders will be placed every 2 weeks. Contact Jen Roehrig at 610-637-7635 or cuinoc@verizon.net with any questions.
Name

Customer #

Check #

Order Date

Product

Total

Product

A.C. Moore $25.00

5%

Cabela's $25.00

Amazon.com $100.00

3%

Amazon.com $25.00

3%

AMC Theatres $25.00

8%

10%

American Girl $25.00

9%

Applebee's $25.00

8%

Applebee's $50.00

8%

Babies"R"Us $100.00

3%

Babies"R"Us $20.00

3%

American Eagle
Outfitters $25.00

% QTY

Total

Product

11%

Famous Footwear
$25.00

8%

Carrabba's Italian Grill

$25.00

8%

Fleming's Prime
Steakhouse $25.00

8%

Carrabba's Italian Grill

$50.00

8%

Foot Locker $25.00

9%

10%

GameStop $25.00

3%

Champs Sports $25.00

9%

Gap $100.00

14%

Children's Place $25.00

12%

Gap $25.00

14%

Chili's Grill & Bar $25.00

11%

Giant Food Stores

$100.00

4%

Chili's Grill & Bar $50.00

11%

10%

Giant Food Stores

$25.00

4%

Chipotle Mexican Grill

$10.00

7%

Giant Food Stores

$50.00

4%

Christmas Tree Shops

$25.00

GNC $25.00

8%

8%

Great Harvest Bread

$10.00

6%

Gymboree $25.00

13%

Hallmark $25.00

4%

12%

IHOP $25.00

8%

iTunes $15.00

5%

Carter's $25.00

% QTY

Bahama Breeze
$25.00

9%

Baja Fresh $25.00

7%

Chuck E. Cheese
$10.00

Barnes & Noble $10.00

9%

Claire's $10.00

9%

9%

% QTY

Total

Barnes & Noble

$100.00

9%

Container Store
$100.00

Barnes & Noble $25.00

9%

Container Store $25.00

9%

Bath & Body Works

$10.00

13%

Cracker Barrel $25.00

9%

Bath & Body Works

$25.00

13%

Crate and Barrel

$100.00

8%

Bed Bath & Beyond

$100.00

7%

Crate and Barrel $25.00

8%

iTunes $25.00

5%

CVS Pharmacy $100.00

6%

J. Crew $25.00

13%

Bed Bath & Beyond

$25.00

7%

CVS Pharmacy $25.00

6%

Jiffy Lube $30.00

8%

Bertuccis Italian
Restaurant $25.00

10%

Dairy Queen $10.00

3%

Jo-Ann Fabric and Craft

Stores $25.00

6%

Best Buy $100.00

4%

13%

Kmart $25.00

4%

Denny's $10.00

7%

Kmart $50.00

4%

Dick's Sporting Goods

$100.00

8%

Kohl's $100.00

4%

Dick's Sporting Goods

$25.00

8%

Kohl's $25.00

4%

Disney $100.00

2%

L.L.Bean $100.00

16%

Disney $25.00

2%

L.L.Bean $25.00

16%

Dressbarn $25.00

8%

Lands' End $100.00

16%

Lands' End $25.00

16%

Best Buy $25.00

4%

Bloomingdale's $100.00

12%

Bloomingdale's $25.00

12%

Bonefish Grill $25.00

8%

Bonefish Grill $50.00

8%

Boscov's $25.00

8%

Buca di Beppo $25.00

8%

Buffalo Wild Wings

$10.00

8%

Buffalo Wild Wings

$25.00

8%

Build-A-Bear Workshop
$25.00
Cabela's $100.00

Dave & Buster's $25.00

Honey Baked Ham

$25.00

Dunkin' Donuts $10.00

3%

Dunkin' Donuts $25.00

3%

LongHorn Steakhouse
$25.00

9%

EB Games $25.00

3%

Lord & Taylor $25.00

8%

8%

Einstein Bros. Bagels

$10.00

10%

Lowe's $100.00

4%

10%

Express $25.00

4%

11%

11%

Make Checks Payable To:

Culbertson PTO

Lowe's $25.00
Macaroni Grill $25.00

Total Due All Columns:

Created: 10/2/2016 2:19:28 PM

Family Order Form

Culbertson Elementary Parent Teacher Organization

2% - 20% of your order will go to our children's education at Culbertson. Send orders and payment in an envelope marked Tiger Mall.
Orders will be placed every 2 weeks. Contact Jen Roehrig at 610-637-7635 or cuinoc@verizon.net with any questions.
Name

Customer #

Check #

Order Date

Product

Total

Product

Total

Product

Macy's $100.00

10%

% QTY

Rainforest Cafe $25.00

9%

% QTY

Walgreens $25.00

Macy's $25.00

10%

Red Lobster $25.00

9%

Maggiano's Little Italy

$25.00

11%

Regal Theatres $25.00

8%

Men's Wearhouse
$25.00

8%

Rite Aid $25.00

Ruby Tuesday $25.00

Michaels $25.00

4%

Neiman Marcus $50.00

12%

Nike $25.00

12%

Office Depot / Office

Max $100.00

5%

Office Depot / Office

Max $25.00

5%

Old Navy $100.00

14%

Old Navy $25.00

Walmart $100.00

2.5%

Walmart $25.00

2.5%

4%

Wawa $100.00

1.5%

8%

Wawa $25.00

1.5%

Ruth's Chris Steak

House $50.00

10%

Wendy's $10.00

4%

Sam's Club $100.00

2.5%

Whole Foods Market

$100.00

3%

Sam's Club $25.00

2.5%

Whole Foods Market

$25.00

3%

Sears $100.00

4%

Sears $25.00

4%

Sephora $20.00

5%

14%

Shutterfly $25.00

9%

9%

Staples $100.00

5%

Omaha Steaks $25.00

11%

Staples $25.00

5%

On The Border $25.00

11%

Starbucks $10.00

7%

Oriental Trading
Company $25.00

9%

Starbucks $25.00

7%

Outback Steakhouse
$25.00

8%

Stein Mart $25.00

7%

$
$

8%

SUBWAY Restaurants
$10.00

6%

Outback Steakhouse
$50.00

8%

SUBWAY Restaurants
$50.00

6%

Overstock.com $25.00
Overton's $25.00

8%

7%

P.F. Chang's China

Bistro $25.00

8%

T.J.
Maxx/Marshalls/HomeG
oods $100.00

9%

T.J.
Maxx/Marshalls/HomeG
oods $25.00

7%

Panera Bread $10.00

Panera Bread $25.00

9%

Talbots $25.00

13%

Papa John's Pizza

$10.00

8%

Target $100.00

2.5%

13%

Target $25.00

2.5%

4%

Target $50.00

2.5%

9%

Pep Boys $20.00

PetSmart $25.00

4%

TGI Fridays $25.00

Pier 1 Imports $25.00

9%

The Home Depot

$100.00

4%

Pizzeria Uno $25.00

12%

8%

The Home Depot

$25.00

4%

Pottery Barn $100.00

Toys"R"Us $20.00

3%

Pottery Barn $25.00

8%

$
Under Armour $25.00

11%

Pottery Barn Kids

$25.00

8%

$
$

7%

United Artist Theatres

$25.00

8%

Qdoba Mexican Grill

$25.00

12%

Make Checks Payable To:

Total
$

Olive Garden $25.00

Payless Shoes $20.00

% QTY
6%

Uno Pizzeria & Grill

$25.00

Culbertson PTO

Total Due All Columns: