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Family Order Form 2016

The document is a family order form for the Culbertson Elementary Parent Teacher Organization. It lists over 100 retailers and the percentage of each order that will be donated to the school. Orders are placed every two weeks and customers should contact Jen Roehrig with any questions. The form requests the customer's name, number, check information and total amount due for all items ordered.

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John Michael
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172 views2 pages

Family Order Form 2016

The document is a family order form for the Culbertson Elementary Parent Teacher Organization. It lists over 100 retailers and the percentage of each order that will be donated to the school. Orders are placed every two weeks and customers should contact Jen Roehrig with any questions. The form requests the customer's name, number, check information and total amount due for all items ordered.

Uploaded by

John Michael
Copyright
© Public Domain
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Created: 10/2/2016 2:19:28 PM

Family Order Form

Culbertson Elementary Parent Teacher Organization


2% - 20% of your order will go to our children's education at Culbertson. Send orders and payment in an envelope marked Tiger Mall.
Orders will be placed every 2 weeks. Contact Jen Roehrig at 610-637-7635 or [email protected] with any questions.
Name

Customer #

Check #

Order Date

Product

Total

Product

A.C. Moore $25.00

5%

Cabela's $25.00

Amazon.com $100.00

3%

Amazon.com $25.00

3%

AMC Theatres $25.00

8%

10%

American Girl $25.00

9%

Applebee's $25.00

8%

Applebee's $50.00

8%

Babies"R"Us $100.00

3%

Babies"R"Us $20.00

3%

American Eagle
Outfitters $25.00

% QTY

Total

Product

11%

Famous Footwear
$25.00

8%

Carrabba's Italian Grill


$25.00

8%

Fleming's Prime
Steakhouse $25.00

8%

Carrabba's Italian Grill


$50.00

8%

Foot Locker $25.00

9%

10%

GameStop $25.00

3%

Champs Sports $25.00

9%

Gap $100.00

14%

Children's Place $25.00

12%

Gap $25.00

14%

Chili's Grill & Bar $25.00

11%

Giant Food Stores


$100.00

4%

Chili's Grill & Bar $50.00

11%

10%

Giant Food Stores


$25.00

4%

Chipotle Mexican Grill


$10.00

7%

Giant Food Stores


$50.00

4%

Christmas Tree Shops


$25.00

GNC $25.00

8%

8%

Great Harvest Bread


$10.00

6%

Gymboree $25.00

13%

Hallmark $25.00

4%

12%

IHOP $25.00

8%

iTunes $15.00

5%

Carter's $25.00

% QTY

Bahama Breeze
$25.00

9%

Baja Fresh $25.00

7%

Chuck E. Cheese
$10.00

Barnes & Noble $10.00

9%

Claire's $10.00

9%

9%

% QTY

Total

Barnes & Noble


$100.00

9%

Container Store
$100.00

Barnes & Noble $25.00

9%

Container Store $25.00

9%

Bath & Body Works


$10.00

13%

Cracker Barrel $25.00

9%

Bath & Body Works


$25.00

13%

Crate and Barrel


$100.00

8%

Bed Bath & Beyond


$100.00

7%

Crate and Barrel $25.00

8%

iTunes $25.00

5%

CVS Pharmacy $100.00

6%

J. Crew $25.00

13%

Bed Bath & Beyond


$25.00

7%

CVS Pharmacy $25.00

6%

Jiffy Lube $30.00

8%

Bertuccis Italian
Restaurant $25.00

10%

Dairy Queen $10.00

3%

Jo-Ann Fabric and Craft


Stores $25.00

6%

Best Buy $100.00

4%

13%

Kmart $25.00

4%

Denny's $10.00

7%

Kmart $50.00

4%

Dick's Sporting Goods


$100.00

8%

Kohl's $100.00

4%

Dick's Sporting Goods


$25.00

8%

Kohl's $25.00

4%

Disney $100.00

2%

L.L.Bean $100.00

16%

Disney $25.00

2%

L.L.Bean $25.00

16%

Dressbarn $25.00

8%

Lands' End $100.00

16%

Lands' End $25.00

16%

Best Buy $25.00

4%

Bloomingdale's $100.00

12%

Bloomingdale's $25.00

12%

Bonefish Grill $25.00

8%

Bonefish Grill $50.00

8%

Boscov's $25.00

8%

Buca di Beppo $25.00

8%

Buffalo Wild Wings


$10.00

8%

Buffalo Wild Wings


$25.00

8%

Build-A-Bear Workshop
$25.00
Cabela's $100.00

Dave & Buster's $25.00

Honey Baked Ham


$25.00

Dunkin' Donuts $10.00

3%

Dunkin' Donuts $25.00

3%

LongHorn Steakhouse
$25.00

9%

EB Games $25.00

3%

Lord & Taylor $25.00

8%

8%

Einstein Bros. Bagels


$10.00

10%

Lowe's $100.00

4%

10%

Express $25.00

4%

11%

11%

Make Checks Payable To:

Culbertson PTO

Lowe's $25.00
Macaroni Grill $25.00

Total Due All Columns:

Created: 10/2/2016 2:19:28 PM

Family Order Form

Culbertson Elementary Parent Teacher Organization


2% - 20% of your order will go to our children's education at Culbertson. Send orders and payment in an envelope marked Tiger Mall.
Orders will be placed every 2 weeks. Contact Jen Roehrig at 610-637-7635 or [email protected] with any questions.
Name

Customer #

Check #

Order Date

Product

Total

Product

Total

Product

Macy's $100.00

10%

% QTY

Rainforest Cafe $25.00

9%

% QTY

Walgreens $25.00

Macy's $25.00

10%

Red Lobster $25.00

9%

Maggiano's Little Italy


$25.00

11%

Regal Theatres $25.00

8%

Men's Wearhouse
$25.00

8%

Rite Aid $25.00


Ruby Tuesday $25.00

Michaels $25.00

4%

Neiman Marcus $50.00

12%

Nike $25.00

12%

Office Depot / Office


Max $100.00

5%

Office Depot / Office


Max $25.00

5%

Old Navy $100.00

14%

Old Navy $25.00

Walmart $100.00

2.5%

Walmart $25.00

2.5%

4%

Wawa $100.00

1.5%

8%

Wawa $25.00

1.5%

Ruth's Chris Steak


House $50.00

10%

Wendy's $10.00

4%

Sam's Club $100.00

2.5%

Whole Foods Market


$100.00

3%

Sam's Club $25.00

2.5%

Whole Foods Market


$25.00

3%

Sears $100.00

4%

Sears $25.00

4%

Sephora $20.00

5%

14%

Shutterfly $25.00

9%

9%

Staples $100.00

5%

Omaha Steaks $25.00

11%

Staples $25.00

5%

On The Border $25.00

11%

Starbucks $10.00

7%

Oriental Trading
Company $25.00

9%

Starbucks $25.00

7%

Outback Steakhouse
$25.00

8%

Stein Mart $25.00

7%

$
$

8%

SUBWAY Restaurants
$10.00

6%

Outback Steakhouse
$50.00

8%

SUBWAY Restaurants
$50.00

6%

Overstock.com $25.00
Overton's $25.00

8%

7%

P.F. Chang's China


Bistro $25.00

8%

T.J.
Maxx/Marshalls/HomeG
oods $100.00

9%

T.J.
Maxx/Marshalls/HomeG
oods $25.00

7%

Panera Bread $10.00


Panera Bread $25.00

9%

Talbots $25.00

13%

Papa John's Pizza


$10.00

8%

Target $100.00

2.5%

13%

Target $25.00

2.5%

4%

Target $50.00

2.5%

9%

Pep Boys $20.00


PetSmart $25.00

4%

TGI Fridays $25.00

Pier 1 Imports $25.00

9%

The Home Depot


$100.00

4%

Pizzeria Uno $25.00

12%

8%

The Home Depot


$25.00

4%

Pottery Barn $100.00

Toys"R"Us $20.00

3%

Pottery Barn $25.00

8%

$
Under Armour $25.00

11%

Pottery Barn Kids


$25.00

8%

$
$

7%

United Artist Theatres


$25.00

8%

Qdoba Mexican Grill


$25.00

12%

Make Checks Payable To:

Total
$

Olive Garden $25.00

Payless Shoes $20.00

% QTY
6%

Uno Pizzeria & Grill


$25.00

Culbertson PTO

Total Due All Columns:

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