ORDER FORM Name of Student: ______Division/Grade: ______total # of Shoppiong Cards ______

Name of puchuser: ______Email: ______

Department Stores: Grocery Stores: (DB) Giant Tiger 3.0% x $25.00 (DB) MarketPlace IGA 5.0% x $50.00 $ ______x $100.00 $ ______**Reloadable** (DB) Hudson's Bay (Hbc, 3.0% x $25.00 (DB) (Shop Easy, 3.0% x $25.00 Home Outfitters) x $50.00 , Superstore,Lucky x $50.00 x $100.00 $ ______Dollar,No Frills,Canadian Wholesale x $100.00 (DB) 2.0% x $25.00 City Market) x $250.00 $ ______x $50.00 (DB) , and 4.0% x $25.00 x $100.00 $ ______Thrifty Foods x $50.00 (DB) Walmart 2.0% x $25.00 x $100.00 x $50.00 x $250.00 $ ______x $100.00 (DB) Save-On-Foods, 4.0% x $25.00 x $250.00 $ ______Price Smart Foods, x $50.00 x $100.00 Fuel: x $250.00 $ ______(C) Chevron 2.0% x $25.00 $ ______(DB) Stong's 5.0% x $50.00 (DB) Esso 2.0% x $25.00 x $100.00 x $50.00 x $500.00 $ ______x $100.00 $ ______(DB) T&T 2.0% x $25.00 (DB) Petro- 2.0% x $25.00 (Osaka) x $50.00 $ ______x $50.00 x $100.00 $ ______Specialty Stores: (DB) Shell 2.0% x $25.00 (DB) Amazon.ca 2.0% x $25.00 x $50.00 x $50.00 x $100.00 $ ______x $100.00 $ ______(DB) American Eagle 5.0% x $25.00 $ ______Home Improvement: (DB) Bath and Body Works 5.0% x $25.00 $ ______(DB) Home Depot 2.0% x $25.00 (DB) 2.0% x $25.00 x $50.00 x $50.00 x $100.00 x $100.00 $ ______x $250.00 $ ______(DB) Canadian Tire 3.0% x $25.00 (DB) Home Hardware 3.0% x $25.00 x $50.00 x $50.00 x $100.00 $ ______x $100.00 $ ______(DB) Chapters/Indigo/Coles 5.0% x $25.00 (DB) Lowe's 2.0% x $25.00 x $50.00 $ ______x $50.00 (DB) Claire's Stores 7.5% x $25.00 $ ______x $100.00 $ ______(DB) i-Tunes 3.0% x $10.00 (DB) Rona 5.0% x $25.00 x $25.00 $ ______x $50.00 (DB) La Senza 5.0% x $25.00 $ ______x $100.00 $ ______(DB) M&M Meat Shops 3.0% x $25.00 $ ______(DB) Mark's Work 5.0% x $25.00 Grocery Stores: Wearhouse x $50.00 (DB) Choices Market 7.0% x $25.00 x $100.00 $ ______x $100.00 (DB) Options (Gap, Old Navy, 5.0% x $25.00 x $250.00 $ ______Banana Republic) x $50.00 $ ______(DB) Petsmart 3.0% x $25.00 $ ______

More Specialty Next Page Specialty Stores: Restaurants: (DB) Shoppers Drug Mart 3.0% x $25.00 (DB) Sammy J's Grill and Bar 5.0% ______x $25.00 x $50.00 x $50.00 $ ______x $100.00 $ ______(DB) Subway 5.0% x $10.00 (DB) Sport Chek 3.0% x $25.00 x $25.00 x $50.00 x $50.00 $ ______x $100.00 $ ______(DB) Tim Hortons 3.0% x $10.00 (DB) Staples 3.0% x $25.00 x $25.00 x $50.00 x $50.00 $ ______x $100.00 (DB) Dine 10.0% x $50.00 $ ______x $250.00 $ ______(The Teahouse, Seasons in the Park, (DB) Starbucks 5.0% x $10.00 Cardero's, The Sandbar) x $25.00 (DB) Restaurant 5.0% x $25.00 x $50.00 x $50.00 $ ______x $100.00 $ ______(DB) Triple O's 5.0% x $25.00 $ ______(DB) The Children's Place 5.0% x $25.00 $ ______(DB) Winners / Marshalls / 5.0% x $25.00 Home Sense x $50.00 $ ______Entertainment: (DB) Cineplex Odeon 5.0% x $10.00 (Famous Players,Galaxy, x $25.00 SilverCity,Colossus, x $50.00 $ ______Paramount) Travel Restaurants: (DB) Fairmont Hotels 5.0% x $100.00 $ ______(DB) Boathouse Restaurants 5.0% x $25.00 x $50.00 $ ______(DB) Boston 5.0% x $25.00 Spas x $50.00 $ ______(DB) Spa Utopia 5.0% x $50.00 (DB) Browns Socialhouse 5.0% x $25.00 www.spautopia.ca x $100.00 $ ______x $50.00 $ ______(DB) WaySpa 7.5% x $50.00 (DB) Cactus Club 10.0% x $25.00 (over 450 spas across Canada) x $100.00 $ ______x $50.00 $ ______www.wayspa.com (DB) Cara-The Ultimate Dining Card 3.0% x $25.00 (Milestones, Kelseys, Swiss x $50.00 $ ______GRAND TOTAL: $ Chalet, Montana's, New York Fries Harvey's, East Side Marios and more) (DB) Darden Restaurants DB: Declining Balance Shopping Card Olive Garden 5.0% x $25.00 $ ______C: Change Back Shopping Certificate Red Lobster 5.0% x $25.00 $ ______NC: No Change Back Shopping Certificate (DB) Earls 5.0% x $25.00 x $50.00 $ ______(DB) 7.0% x $10.00 CANNOT PAY OFF ACCOUNT WITH CARDS OR CERTIFICATES x $25.00 $ ______(DB) Joey Restaurant 5.0% x $25.00 PAYMENT INFORMATION: o Cheque # ______x $50.00 $ ______o Cash (DB) Keg 5.0% x $25.00 Total Order: $ ______o Visa x $50.00 x $100.00 $ ______Thanks for your support! (DB) McDonald's 3.0% x $10.00 x $25.00 Please note the following cards are also available as reloadable x $50.00 $ ______cards; MarketPlace IGA and Fairway Market. (DB) Moxie's 10.0% x $25.00 $ ______Please phone our office for more information. (DB) Old Spaghetti Factory 5.0% x $25.00 $ ______(DB) Red Robin 5.0% x $25.00 $ ______Revised Apr 2019