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 Best Buy 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 (Famous Players, 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, Toronto 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.