Family Order Form Created: 9/11/2009 3:07:28 PM Hillsboro Elementary School Name Customer # Check # Order Date Product % Qty Total American Express 1.25% $ Barnes & Noble **10% $ $200.00 Booksellers $25.00 "346" Brooks 16% $ Andersons Market, 4% $ Barnes & Noble **10% $ Brothers $25.00 The $100.00 College Bookstores $10.00 1-800-Flowers 25% $ Andersons Market, 4% $ $10.00 The $25.00 Barnes & Noble **10% $ College Bookstores 675 Minute Total 15% $ Andersons, The 4% $ $100.00 Access Phone Card $100.00 $20.00 Barnes & Noble **10% $ Andersons, The 4% $ College Bookstores 99 Restaurant $25.00 13% $ $25.00 $20.00 Antico Posto $25.00 12% $ A Pea in the Pod 6% $ Barnes & Noble **10% $ $25.00 Applebee's $25.00 **10% $ College Bookstores A&P Food Stores 4% $ $25.00 $100.00 Applebee's $50.00 **10% $ Baskin Robbins 9% $ A&P Food Stores 4% $ $2.00 Aquarium $25.00 9% $ $25.00 Bass Pro Shops 9% $ A-Plus Convenience 2% $ Arby's $10.00 8% $ $100.00 Store $250.00 Bass Pro Shops 9% $ Arco $100.00 2% $ A-Plus Convenience 1.50% $ $25.00 Store $50.00 Arco $250.00 3% $ Bath & Body Works 13% $ A.J. Wright $100.00 7.00% $ $10.00 Arco $50.00 2% $ Bath & Body Works 13% $ A.J. Wright $25.00 7.00% $ AT&T 125 Minute 20% $ $25.00 Acapulco Mexican 9% $ Prepaid Card $9.50 bd's Mongolian 8% $ Restaurant Y Cantina Athleta $25.00 **11% $ Barbecue $20.00 $25.00 Beauty Bar $25.00 8% $ Ace Hardware 4% $ Auto Zone $25.00 5% $ $100.00 Bed Bath & Beyond 7.00% $ Avis Car Rental 8% $ $25.00 Ace Hardware $25.00 4% $ $50.00 BedandBreakfast.co 10% $ Acme $100.00 4% $ B. Dalton Booksellers **10% $ m $50.00 $10.00 Acme $25.00 4% $ Belk Department 7.00% $ B. Dalton Booksellers **10% $ Store $25.00 $100.00 Advance Auto Parts 7.00% $ Ben Pao $25.00 12% $ $25.00 B. Dalton Booksellers **10% $ $20.00 Aeropostale $25.00 7.00% $ Bergner's $100.00 8% $ B. Dalton Booksellers **10% $ Albertsons $100.00 4% $ $25.00 Bergner's $25.00 8% $ Babbage's $25.00 3% $ Albertsons $25.00 4% $ Best Buy $100.00 3% $ Babies-R-Us $20.00 1.50% $ Amazon.com 4% $ Best Buy $25.00 3% $ $100.00 Babin's Seafood 9% $ Best Buy $250.00 3% $ Amazon.com $25.00 4% $ House $25.00 Best Cuts $25.00 8% $ Bahama Breeze 9% $ AMC Theatres 7.00% $ $25.00 $25.00 Best Western 12% $ Baja Fresh $25.00 7.00% $ International $100.00 AMC Theatres $9.50 16% $ Best Western 12% $ Banana Republic **11% $ American Airlines 8% $ International $25.00 $25.00 $100.00 Big 5 Sporting Goods 8% $ Barnes & Noble **10% $ American Airlines 8% $ $25.00 Booksellers $10.00 $250.00 Big Bowl $25.00 12% $ Barnes & Noble **10% $ American Eagle 9% $ Booksellers $100.00 Outfitters $25.00 Big Cedar Lodge 9% $ Barnes & Noble **10% $ $100.00 American Express 1.25% $ Booksellers $20.00 $100.00 Make Checks Payable To: Hillsboro Elementary School Total Due All Columns: $ **Limited time bonus offer. Participating retailers and products are subject to change without notice. Family Order Form Created: 9/11/2009 3:07:28 PM Hillsboro Elementary School Name Customer # Check # Order Date Big Cedar Lodge 9% $ BP Gas $250.00 3% $ Carson Pirie Scott 8% $ $25.00 $25.00 BP Gas $50.00 2% $ Big Fish $25.00 9% $ Casa Gallardo 9% $ Brasserie Jo $25.00 12% $ $25.00 Black Angus $25.00 12% $ Cascading Card File 25% $ Brenner's 9% $ $2.96 Blockbuster $10.00 7.00% $ Steakhouse $25.00 Casual Male XL 6% $ Blockbuster Specialty 15% $ Brooks Brothers 16% $ $25.00 Card $12.00 $25.00 Catherines $25.00 6% $ Blockbuster Specialty 15% $ Brooks Brothers 16% $ Card $3.79 Country Club Store Cattle Company 12% $ $25.00 Blockbuster Specialty 15% $ (Alaska & Hawaii) Card $6.00 Bruegger's Bagels 7.00% $ $25.00 $10.00 Bloomingdale's 12% $ Celebrity Cruise 9% $ $100.00 Buca Di Beppo 8% $ Lines $100.00 $25.00 Bloomingdale's 12% $ Central Market 2% $ $25.00 Budget Car Rental 8% $ $100.00 $50.00 Bloomington 9% $ Central Market 2% $ Chophouse $25.00 Build-A-Bear 8% $ $25.00 Workshop $25.00 Blu Bar Lounge 9% $ Century Theatres 4% $ $25.00 Burger King $10.00 4% $ $25.00 Boardwalk Inn $25.00 9% $ Champs Sports 9% $ Cabela's $100.00 11% $ $25.00 Bob Evans $10.00 10% $ Cabela's $25.00 11% $ Charley's Crab 9% $ $25.00 Bon-Ton $100.00 8% $ Cadillac Bar $25.00 9% $ Chart House $25.00 9% $ Bon-Ton $25.00 8% $ Cafe Ba-Ba-Reeba! 12% $ Cheesecake Factory 5% $ $25.00 Bonefish Grill $25.00 5% $ $25.00 California Pizza 4% $ Chevron $100.00 1.50% $ Bookstar $10.00 **10% $ Kitchen $10.00 Bookstar $100.00 **10% $ Cambria Suites 4% $ Chevron $250.00 2% $ $100.00 Chevron $50.00 1.50% $ Bookstar $20.00 **10% $ Cambria Suites 4% $ $50.00 Bookstar $25.00 **10% $ Chevy's Fresh Mex 8% $ Capitol ChopHouse 9% $ Restaurant $25.00 Bookstop $10.00 **10% $ $25.00 Chili's Grill & Bar 11% $ $25.00 Bookstop $100.00 **10% $ Captain Crabs Take- 9% $ Away $25.00 Chipotle $10.00 10% $ Bookstop $20.00 **10% $ Carl's Jr. $10.00 9% $ Chop House Brewery 6% $ Bookstop $25.00 **10% $ Carlos O'Kelly's 9% $ $25.00 Mexican Cafe $10.00 Chuck E. Cheese 8% $ Borders $10.00 9% $ Carlton Hair 8% $ $10.00 Borders $25.00 9% $ International $25.00 CinéArts $25.00 4% $ Carnival Cruises 8% $ BoRics $25.00 8% $ $100.00 Cinema de Lux 9% $ $25.00 Boscov's Department 5% $ Carrabba's Italian 5% $ Store $25.00 Grill $25.00 Cinemark $25.00 4% $ Boston Market 12% $ Carrows Restaurant 8% $ Cinemark Tinseltown 4% $ $10.00 $10.00 $25.00 Boston Store $100.00 8% $ Carrs $100.00 4% $ Cineplex Odeon 7.00% $ $25.00 Boston Store $25.00 8% $ Carrs $25.00 4% $ Cineplex Odeon 16% $ BP Gas $100.00 2% $ Carson Pirie Scott 8% $ $9.50 $100.00 Make Checks Payable To: Hillsboro Elementary School Total Due All Columns: $ **Limited time bonus offer. Participating retailers and products are subject to change without notice. Family Order Form Created: 9/11/2009 3:07:28 PM Hillsboro Elementary School Name Customer # Check # Order Date Circle K $25.00 2% $ D'Angelo Grilled 10% $ Edwards Theater 8% $ Sandwiches $10.00 $25.00 Claim Jumper 8% $ Restaurants $25.00 Damon's Grill $25.00 9% $ Edwards Theater 15% $ $9.50 Claire's $10.00 9% $ Darden Restaurants 9% $ $25.00 Eiffel Tower $25.00 12% $ Clarion Hotels 4% $ $100.00 Dave & Busters 13% $ El Paso Cantina 9% $ $25.00 $25.00 Clarion Hotels $50.00 4% $ Del Taco $10.00 4% $ El Pollo Loco $10.00 6% $ Coco's Restaurant & 8% $ Bakery $10.00 Dell Computer 4% $ El Torito $25.00 9% $ $100.00 Coffee Bean & Tea 9% $ El Torito Grill $25.00 9% $ Leaf $25.00 Dennis Uniform 5% $ $20.00 Elder-Beerman 8% $ Cold Stone Creamery 8% $ $100.00 $10.00 Denny's $10.00 7.00% $ Elder-Beerman 8% $ Comfort Inn $100.00 4% $ Destination Maternity 6% $ $25.00 $25.00 Comfort Inn $50.00 4% $ Electronics Boutique 3% $ Di Pescara $25.00 12% $ $25.00 Comfort Suites 4% $ $100.00 Dick's Sporting 8% $ Everest $25.00 12% $ Goods $25.00 Comfort Suites 4% $ Express $25.00 10% $ $50.00 Dillard's $100.00 9% $ Express for Men 10% $ Community Canteen 12% $ Dillard's $25.00 9% $ $25.00 $25.00 Disney $100.00 2% $ Exxon $250.00 2% $ Container Store 9% $ $100.00 Disney $1000.00 2% $ Exxon $50.00 1.50% $ Container Store 9% $ $25.00 Disney $25.00 2% $ f.y.e. $25.00 6% $ Cool Cuts $25.00 8% $ Dominick's $100.00 4% $ Fairfield Inn $100.00 8% $ Country Buffet $25.00 5% $ Dominick's $25.00 4% $ Fairfield Inn $50.00 8% $ Courtyard $100.00 8% $ Domino's Pizza 5% $ Fairfield Inn $500.00 8% $ $5.00 Courtyard $50.00 8% $ Fairmont Hotels 12% $ Domino's Pizza & 2- 25% $ $100.00 Courtyard $500.00 8% $ liter $14.00 Family Christian 9% $ Don & Charlie's 12% $ Stores $25.00 Cousin's Subs $10.00 9% $ Steakhouse $25.00 Family Express 4% $ Crab House, The 9% $ Donatos Pizza 10% $ $100.00 $25.00 $10.00 Family Express 4% $ Cracker Barrel 9% $ Downtown Aquarium 9% $ $25.00 $10.00 $25.00 Family Video $10.00 12% $ Crate and Barrel 8% $ Dream Dinners 8% $ $100.00 $75.00 Famous Hair $25.00 8% $ Crate and Barrel 8% $ Dressbarn $25.00 8% $ $25.00 Fannie May Candies 25% $ Dunham's Sports 8% $ $10.00 Crew Cuts $25.00 13% $ $25.00 Fashion Bug $25.00 6% $ Cub Foods $100.00 2% $ Dunkin' Donuts 4% $ $10.00 Fazoli's $25.00 7.00% $ Cub Foods $25.00 2% $ Eat 'n Park $10.00 10% $ Fiesta Salons $25.00 8% $ CVS/pharmacy **8% $ $100.00 Eat 'n Park $25.00 10% $ Finish Line $25.00 10% $ CVS/pharmacy **8% $ EB Games $25.00 3% $ Fire Mountain $25.00 5% $ $25.00 EBX $25.00 3% $ Make Checks Payable To: Hillsboro Elementary School Total Due All Columns: $ **Limited time bonus offer. Participating retailers and products are subject to change without notice. Family Order Form Created: 9/11/2009 3:07:28 PM Hillsboro Elementary School Name Customer # Check # Order Date First Choice 8% $ GFS Marketplace 4% $ HEB $100.00 2% $ Haircutters $25.00 $25.00 HEB $25.00 2% $ Fish Tales $25.00 9% $ Giant Eagle $100.00 4% $ Herberger's $100.00 8% $ Fisherman's Wharf 9% $ Giant Eagle $25.00 4% $ $25.00 Herberger's $25.00 8% $ Giant Foods $100.00 4% $ Fleming's Prime 5% $ Steakhouse $25.00 Hilton Galveston 9% $ Giant Foods $25.00 4% $ Island Resort $25.00 Flying Dutchman, 9% $ The $25.00 Gift card Wrapper 16 20% $ Hilton Madison 9% $ pk $5.60 Monona Terrace Food Basics $100.00 4% $ $25.00 GNC $25.00 8% $ Food Basics $25.00 4% $ Hilton Milwaukee City 9% $ Golden Nugget 9% $ Center $25.00 $25.00 Food Emporium 4% $ Hilton 9% $ $100.00 Golfsmith $25.00 8% $ Minneapolis/Bloomin Food Emporium 4% $ gton $25.00 $25.00 Goodrich Quality 4% $ Theaters $10.00 Holiday Hair $25.00 8% $ foodlife $25.00 12% $ Gordman's $25.00 7.00% $ Holiday Inn on the 9% $ Foot Locker $25.00 9% $ Beach-Galveston, TX Gordon Food Service 4% $ $25.00 Footaction USA 9% $ Marketplace $100.00 Holiday Station 2% $ $25.00 Gordon Food Service 4% $ Stores $25.00 Four Points by 9% $ Marketplace