Gift Card Order Form

Vendor Qty Amt Qty Amt Total Vendor Qty Amt Qty Amt Total Department Stores, Clothing, and Accessories Specialty Stores Babies R Us / Toys R Us $25 Bed Bath & Beyond $25 ** Bloomingdale’s $25 Crate & Barrel $25 The Children’s Place $25 Lowe’s $25 $100 claire’s / ICING $10 The Home Depot $25 $100 Gap / Old Navy / $25 Jo-Ann Fabric & Crafts $25 Banana Republic / Piperlime Michaels Arts & Crafts $25 Gymboree $25 Sports / Sporting Goods Kohl’s $25 Big 5 Sporting Goods $25 Macy’s $25 DICK'S Sporting Goods $25 ** Ross Dress For Less $25 Sports Authority $25 ** Target $25 $100 T.J.Maxx / Marshalls / HomeGoods $25 Special Orders (Please call ahead) Books, Music, and Online Food / Groceries Amazon $25 $100 Marie Callenders’s $25 Barnes & Noble $10 $25 California Pizza Kitchen $10 Groupon.com $25 Cold Stone Creamery $10 iTunes $15 $25 Claim Jumper $25 $100 Dave and Buster’s $25 Dining Applebee’s $25 Gas Cards / Auto Rentals / Circle One Chili’s Grill and Bar $25 Chevron / Mobil / Shell $25 $50 The Cheesecake Factory $25 Avis / Budget / Car Rental $50 Coco’s $10 Hotel / Motel / Crusies Denny’s $25 Best Western $25 $100 Mimi’s Café $25 Disney $100 $1000 Olive Garden $25 Fairmont Hotels $100 Panera Bread $10 $25 Hyatt Hotels $50 $100 P.F. Chang’s China Bistro / $25 Marriott Hotels & Resorts $50 $500 Pei Wei Asian Diner Carnival or Celebrity $100 $1000 Souplantation $25 Misc. Dining on the Go RiteAid $25 Coffee Bean & Tea Leaf $25 ULTA Beauty $25 Einstein Bros. Bagels $10 The Container Store $25 $100 Jamba Juice $10 Best Buy $25 Starbucks $10 $25 RadioShack $25 Subway $10 $50 American Eagle Outfitters $25 Groceries DSW $25 Albertsons $25 $100 Zappos.com $25 Sprouts Farmers Market $25 $100 Pick-Up Date Requested: ______Vons $25 $100 Whole Foods Market $25 Daytime Phone Number: ______Entertainment Payment Method: AMC Theatres $25 ❏ Check Regal / United / Edwards $25 ❏ Credit Card ❏ Debit Card Health and Beauty ❏ Visa ❏ MasterCard ❏ Discover CVS / Pharmacy $25 $100 Walgreens $25 $100 Name on Card ______Sephora $20 Card Number ______Bath & Body Works $10 $25 Billing Address ______

______** Larger denominations available upon request. Inquire about other cards. Security Code ______Expiration Date ______Revised September 16, 2012 Tifereth Israel Synagogue 6660 Cowles Mountain Boulevard • San Diego, CA 92119 • 619 697-6001 • fax 619 697-1102 • www.tiferethisrael.com