<p>Saint Dorothy – Dot’s Dollars Program Date______Total # of Cards ______Cash ______</p><p>Name ______Phone # ______Total Amount $______Check # ______Address ______</p><p>Please make check payable to Saint Dorothy H & S Dollar Stores Amount Discount # of cards Amount Stores Amount Discount # of cards Acme $25 3% ShopRite $25 3% Acme $100 3% ShopRite $100 3% Amazon.co m $25 2.25% Staples $25 3.75% The Amazon.co Children's m $100 2.25% Place $25 9% American Girl Doll $25 6.75% Target $25 1.875% TJ Maxx/ Barnes & Home Noble Goods/ Bookstores $10 6.75% Marshalls $25 5.25% Bath & Toys/Kids/ Body Babies-R- Works $10 9.75% Us 20 2.25% Bed, Bath & Beyond $25 5.25% Wal-Mart $25 1.875% Claire's $10 6.75% Wawa $25 1.125% CVS $25 4.5% Arby’s $10 6% Dick's Chipotle Sporting Mexican Goods $25 6% Grill $10 7.5% Game Stop/ EB Dairy Games $25 2.25% Queen $10 2.25% Gap Tri- Card(Bana na Republic, Old Navy, & Gap) $25 10.5% Dominos $10 6% Giant Dunkin Foods $25 3% Donuts $10 2.25% Giant Panera Foods $50 3% Bread $10 6.75% Giant Perfect Foods $100 3% Circle $10 37.5% Great Clips $25 6% Pizza Hut $10 6% Home Outback/B Depot $25 3% onefish $25 6% ITunes $15 3.75% Qdoba $25 5.25% Jo-Ann $25 4.5% Quiznos $10 3% Fabric Stores Kohl's $10 3.75% Rita's $5 7.5% Kohl’s $25 3.75% Starbucks $10 5.25% Kohl’s $50 3.75% Subway $10 4.5% Swiss Kohl’s $100 3% Farms $25 3.75% Tony L.L.Bean $25 12% Roni's $10 7.5% Lands’ End $25 12% Wendy's $10 3% Lowes Home Improvem AMC ent $25 3% Theaters $25 6% AMC Single Payless $20 9.75% Ticket $9.50 7.5% Regal Single Rite Aid $25 3% Ticket $10 7.5% Ross 6% Colu mn 2 TOTA Column 1 TOTAL L</p><p>GRAN D TOTA L</p>