FAMILY ORDER FORM Phone Profit Name : Revision 15-Nov-2013 Comments : Order Date : DD-MON-YYYY QTY DEN % SUB-TOTAL D American Eagle, Aerie, 77kids 25 5.0% D Bath & Body Works 25 7.0% D Best Buy 25 1.5% D 100 1.5% D The Body Shop 25 7.0% D Boston Pizza 25 7.0% DS CANADIAN TIRE, CANADIAN TIRE GAS 25 4.0% O U P G R S E V I N T E N C I N G E V A DS 50 4.0% DS 100 4.0% D Cara - Swiss Chalet, Kelsey's, Harvey's, Montana's, Milestones, 25 4.0% D Coza Tuscan 50 4.0% D Chapter's, Indigo, Coles, World's Biggest Book Store 10 10.0% D 25 10.0% D The Children's Place 25 9.0% P Cineplex, Galaxy, Famous, SilverCity, Coliseum, Colossus, Paramount Admit One 10 6.5% P Cineplex, Galaxy, Famous, SilverCity, Coliseum, Colossus, Paramount Child's Night Out 13.50 8.0% D Cineplex Gift Card 25 4.0% D Earls Restaurants 25 7.0% DS Esso, On The Run 25 2.5% DS 50 2.5% DS 100 2.5% D Fairmont Hotels 50 12.0% D Future Shop 25 1.5% D 100 1.5% D The Gap, Gap Kids, Baby Gap, Old Navy, Banana Republic 25 7.0% D Giant Tiger, Tigre Geant, Scott's Discount, Chez Tante Marie 25 3.5% D The Home Depot 25 3.0% D 100 3.0% D Home Hardware 25 3.5% D 100 3.5% DS HBC - The Bay, Zellers, Home Outfitters 25 3.5% DS 100 3.5% D THE KEG 25 8.0% D 50 8.0% D 100 8.0% D Kent Building Supplies 25 3.0% D Kernels Popcorn - get a free two for one coupon with each gift card 10 7.0% D La Senza, La Senza Girl, Silk and Satin 25 7.0% D Laura Secord 25 10.0% D Loblaws, No Frills, Zehrs, Fortinos, Valu-mart, Extra Foods, Independent, 50 3.5% D Atlantic / Real Canadian Superstore, Maxi, Provigo, Real Canadian 100 3.5% D Wholesale, National Grocers, SaveEasy, SuperValu 250 3.5% D Longos 50 3.5% D Mark's Work Warehouse, L'Equipeur 25 7.0% D Marriott 50 8.0% D Metro, Food Basics 50 3.5% DS M & M Meat Shops 25 4.0% D Moores 25 5.0% D Moxies Classic Grill 25 10.0% D Payless ShoeSource 25 10.0% D Petro-Canada 25 3.0% D 50 3.0% D 100 3.0% D Pier 1 Imports 25 5.0% D Pioneer Petroleums 50 1.5% D Pizza Pizza, Pizza 73 25 10.0% D Prime Pubs, East Side Mario's, Casey's Bar & Grill, Bier Market 25 7.0% DP Rainbow Cinema & Magic Lantern Certificate 5 7.0% D Red Lobster, Olive Garden 25 7.0% D Rona, Reno-Depot, Totem Building Supplies, Botanix, Chester DAWE 25 5.0% D 100 5.0% D Roots, Roots Kids, Baby Roots, Roots Home 25 15.0% D Safeway, Vons, Carrs, Genuardis, Pavilions, Dominicks, Pak n Save 50 4.0% D Sears, Sears Home, Sears Travel 25 5.5% D 100 5.5% D Shell Canada 50 2.0% D Sheridan Nurseries 25 4.0% D The Shoe Company, Town Shoes 25 7.0% D Shoppers Drug Mart / Pharmaprix 25 3.0% D 100 3.0% D SIR CORP - Jack Astor's, Alice Fazooli's, Far Niente, Reds, Canyon Creek, The Loose Moose 25 10.0% D Sobeys, IGA, Price Chopper, Foodland, FreshCo, Lawtons 25 4.0% D Drugs, Thrifty Foods, Rachelle-Bery 50 4.0% D 100 4.0% DS Sport Chek, Coast Mountain Sports, Nevada Bobs in Sport Check 25 4.0% DS Staples Business Depot 25 3.0% DS 100 3.0% D Starbucks 25 5.0% D Tim Hortons 25 4.0% D TOYS R US, BABIES R US 25 2.0% D Ultramar Gas 50 2.0% D WaySpa 50 10.0% D Wendy's Restaurants 10 3.0% D West49, Billabong, Duke's Northshore 25 6.0% D Winners, Home Sense, Marshalls 25 8.0% D 100 8.0% Profit Earned for your Organization 0.00 TOTAL D = Declining Balance, S = In Store Rewards, P = Paper.