Due Date: Dec 1st Southridge Grade 12 Gift Card Fundraiser ORDER FORM 2014

NAME OF PURCHASER: ______STUDENT NAME: ______ADDRESS: ______PHONE NUMBER: ______STUDENT GRADE: ______DATE: ______EMAIL: ______PARENT NAME: ______

MERCHANT Profit CERTIFICATES TOTAL MERCHANT Profit CERTIFICATES TOTAL Department Stores: Grocery Stores: Giant Tiger 3.0% x $25.00 Loblaws (Shop Easy, No Frills, 3.0% x $25.00 x $100.00 $ ______Extra Foods, Superstore,Lucky x $50.00 Hudson's Bay (Hbc, 3.0% x $25.00 Dollar, Canadian Wholesale) x $100.00 Home Outfitters) x $50.00 x $250.00 $ ______x $100.00 $ ______Safeway 3.0% x $50.00 London Drugs 2.0% x $25.00 x $100.00 x $50.00 x $250.00 $ ______x $100.00 $ ______Stong's 6.0% x $50.00 Sears 3.0% x $25.00 x $100.00 **Reloadable** x $50.00 x $500.00 $ ______x $100.00 $ ______T&T Supermarkets 2.0% x $20.00 Walmart 1.0% x $25.00 (Osaka) x $50.00 $ ______x $50.00 x $100.00 Specialty Stores: x $250.00 $ ______Aeropostale 7.0% x $25.00 $ ______Fuel: Aldo 7.0% x $25.00 $ ______Chevron 2.0% x $25.00 $ ______American Eagle 5.0% x $25.00 $ ______Esso 2.0% x $25.00 Bath and Body Works 7.0% x $25.00 $ ______**Reloadable** x $50.00 2.0% x $25.00 x $100.00 $ ______x $50.00 Petro-Canada 2.0% x $25.00 x $100.00 $ ______x $50.00 Canadian Tire 3.5% x $25.00 x $100.00 $ ______x $50.00 Shell 3.0% x $25.00 x $100.00 $ ______x $50.00 Chapters/Indigo/Coles*** 10.0% x $20.00 x $100.00 $ ______x $50.00 $ ______Home Improvement: Claire's Stores 9.0% x $25.00 $ ______Home Depot 2.0% x $25.00 Esquires Coffee 10.0% x $10.00 x $50.00 x $25.00 $ ______x $100.00 Future Shop 2.0% x $25.00 x $250.00 $ ______x $50.00 Home Hardware 3.0% x $25.00 x $100.00 $ ______x $50.00 i-Tunes 4.0% x $10.00 x $100.00 $ ______x $25.00 $ ______Lowe's 2.0% x $25.00 Kernels 5.0% x $10.00 x $50.00 x $25.00 $ ______x $100.00 $ ______La Senza 7.0% x $25.00 $ ______Rona / Totem 5.0% x $25.00 M&M Meat Shops 3.0% x $25.00 $ ______x $50.00 Maison Birks 7.0% x $100.00 $ ______x $100.00 $ ______Mark's Work 7.0% x $25.00 Grocery Stores: Wearhouse x $50.00 Choices Market 7.0% x $20.00 x $100.00 $ ______x $100.00 Options (Gap, Old Navy , 7.0% x $25.00 x $250.00 $ ______Banana Republic) x $50.00 $ ______MarketPlace IGA 5.0% x $50.00 $ ______Petsmart 3.0% x $25.00 $ ______**Reloadable** Pet Solutions 7.0% x $25.00 $ ______Killarney Market 3.0% x $25.00 $ ______Pottery Barn 5.0% x $25.00 $ ______Fairway Market *Vancouver Island* 5.0% x $25.00 $ ______Running Room 7.0% x $25.00 $ ______MERCHANT Profit CERTIFICATES TOTAL MERCHANT Profit CERTIFICATES TOTAL Specialty Stores: Restaurants: Shoppers Drug Mart 3.0% x $25.00 Vancouver Dine 10.0% x $50.00 $ ______x $50.00 (The Teahouse, The Sandbar, x $100.00 $ ______Cardero's, Seasons in the Park) Sport Chek 4.0% x $25.00 Wendy's Restaurant 3.0% x $25.00 $ ______x $50.00 White Spot Restuarant*** 7.0% x $25.00 x $100.00 $ ______x $50.00 $ ______Staples 3.0% x $25.00 Triple O's 7.0% x $25.00 $ ______**Reloadable** x $50.00 x $100.00 Entertainment: x $250.00 $ ______Cineplex Odeon 5.0% x $10.00 Starbucks 5.0% x $10.00 (, Paramount x $25.00 $ ______x $25.00 Galaxy, Colossus, SilverCity) x $50.00 Rogers (The Shopping Channel, 7.0% x $10.00 x $100.00 $ ______Rogers Plus, Blue Jays) x $20.00 $ ______The Children's Place 7.0% x $25.00 $ ______Tisol Pet Nutrition and 7.0% x $25.00 Travel Supply Stores x $50.00 Avis Car Rental 7.0% x $50.00 x $100.00 $ ______x $100.00 $ ______Toys 'R' Us 2.0% x $25.00 $ ______Budget Car Rental 7.0% x $50.00 $ ______Williams-Sonoma 5.0% x $25.00 $ ______Fairmont Hotels 7.0% x $100.00 $ ______Winners / Marshalls / Home Sense 7.0% x $25.00 x $50.00 $ ______Spas Spafinder Wellness 365 10.0% x $50.00 Restaurants: x $100.00 $ ______Boathouse Restaurants 7.0% x $25.00 Spa Utopia 7.0% x $50.00 x $50.00 $ ______www.spautopia.ca x $100.00 $ ______Boston Pizza 7.0% x $25.00 WaySpa 15.0% x $50.00 x $50.00 $ ______(over 450 spas across Canada) x $100.00 $ ______Browns Socialhouse 7.0% x $25.00 www.wayspa.com x $50.00 $ ______Burger King 5.0% x $25.00 $ ______$ Cactus Club 7.0% x $25.00 x $50.00 $ ______All cards are Declining Balance Shopping Card except: Cara-The Ultimate Dining Card 3.0% x $25.00 Change Back Shopping Certificate: (Milestone's, Kelsey's, Swiss x $50.00 $ ______Chevron, Killarney Market and Triple O's Chalet, Montana's Cookhouse, No Change Back Shopping Certificate: Harvey's, Fionn MacCool's) Maison Birks, Pet Solutions, Avis and Budget car rentals Olive Garden (Darden Restaurant) 7.0% x $25.00 $ ______Red Lobster (Darden Restaurant) 7.0% x $25.00 $ ______*** PLEASE RETURN ORDER AND PAYMENT BY: December 1st, 2014 Earls 7.0% x $25.00 x $50.00 $ ______Make cheques payable to: SOUTHRIDGE SCHOOL Joey Restaurant 7.0% x $25.00 x $50.00 $ ______Keg 5.0% x $25.00 PAYMENT INFORMATION: Cheque # ______x $50.00 x $100.00 $ ______Cash Moxie's 10.0% x $25.00 $ ______Total Order: $ ______Old Spaghetti Factory*** 5.0% x $25.00 $ ______(Bonus $10 card with every $25) Red Robin 7.0% x $25.00 $ ______Thanks for your support! Sammy J's Grill and Bar 7.0% ______x $25.00 $ ______Grads of 2015 (Bonus $5 added to every $50 card) x $50.00 $ ______Subway 5.0% x $10.00 ***Please note the following cards are also available as reloadable x $25.00 cards; Chapter/Indigo/Coles, The Old Spaghetti Factory and White x $50.00 $ ______Spot Restaruants. Please phone our office for more information.*** Revised October 2014