Rotary Club of Fort St.

John
Box 6306
Fort St John, BC, Canada. V1 J 4H8

September 8th, 2022 Drive - Thru Breakfast - Pre-order Form

Thank you for your interest in pre-ordering your Drive -Thru Breakfasts.
Please complete this form and send in before Wednesday, September 7, 2022, 8:30am.
Details below.
Quantity of breakfasts: ___ for a minimum donation of$10.00 ea Total$____

□ Will picked up at the Drive-Thru Breakfast, located at 9123 100 St, Fort St. John, (Safeway)
between 7:00am and 9:30am

□ DeliverTo --------------------------------
(within Fort St.John, Taylor, Charlie Lake) Address

Name Signature Tel#

Payment will be made by: (check off option) Preferred Delivery Time
- payment by cash or cheque is due on delivery D 7:00-7:30am
D 7:30-8:00am
□ Cash D 8:00-8:30am
D 8:30-9:00am
□ Cheque - made payable to Rotary Club of Fort St John D 9:00-9:30am

□ Credit Card - fill out information below

*Subject lo availability*

Minimum order for delivery - 1 O+

□ Billed to my Rotary Club of FSJ account Return Pre-Order form by

Sept 7, 8:30 am
To any of the following
Phone: (403) 793-0485
e-mail: patricia.chariot.sales@gmail.com

Payment by credit card:

My signature above is authorization to charge $ ________ to

credit card# _________________ / expire date_/_ CVS# ____

All credit card information will be kept secure and shredded after the payment is processed at the
Rotary Club of Fort St John office.

Copy of credit card slip by e-mail? □ No □ Yes

(e-mail address)
Rotary Authorization _________

This form is your invoice and receipt for the breakfasts ordered.
Thank you for supporting Rotary Club of Fort St. John and our local Projects