Purchased by: Name Date: Date Phone #: Phone Number

Student Name: Student Name Grade: Grade or Ministry Name: Ministry Name Check one: Choose an item.

1. Download the form and save it to your computer with a unique name. 2. Fill out the form and save it. 3. Ctrl+Click Submit attach the saved completed form to the E-Mail and click send. Your Order will be ready for pick up by the method you selected on the form Using this form Special orders must be prepaid. Will arrive in about a week

Quantity	Merchant Certificate	Value	Price	$ Amount Due
Quantity	Giant Eagle	$25	$25.00	Amount Due
Quantity	Giant Eagle	$100	$100.00	Amount Due
Quantity	Heinen’s	$25	$25.00	Amount Due
Quantity	Heinen’s	$100	$100.00	Amount Due
Quantity	Marathon	$25	$25.00	Amount Due
Quantity	Marathon	$100	$100.00	Amount Due
Quantity	Sheetz	$25	$25.00	Amount Due
Quantity	Speedway Gasoline	$25	$25.00	Amount Due
Quantity	Speedway Gasoline	$100	$100.00	Amount Due
Quantity	Amazon	$25	$25.00	Amount Due
Quantity	Applebee’s	$25	$25.00	Amount Due
Quantity	Bob Evans	$10	$10.00	Amount Due
Quantity	Arby’s	$10	$10.00	Amount Due
Quantity	Dairy Queen	$10	$10.00	Amount Due
Quantity	Dunkin Donuts	$10	$10.00	Amount Due
Quantity	Chipotle	$10	$10.00	Amount Due
Quantity	Familia’s Deli and Market	$10	$10.00	Amount Due
Quantity	Familia’s Deli and Market	$25	$25.00	Amount Due
Quantity	Honey Baked Ham	$50	$50.00	Amount Due
Quantity	Mangia Mangia	$10	$10.00	Amount Due
Quantity	Mangia Mangia	$20	$20.00	Amount Due
Quantity	Olive Garden /Red Lobster	$25	$25.00	Amount Due
Quantity	Panera Bakery	$10	$10.00	Amount Due
Quantity	Starbucks	$10	$10.00	Amount Due
Quantity	Subway	$15	$15.00	Amount Due
Quantity	Texas Roadhouse	$25	$25.00	Amount Due
Quantity	Wendy’s	$10	$10.00	Amount Due
Quantity	Zeppes	$10	$10.00	Amount Due
Quantity	Bath & Body Works	$25	$25.00	Amount Due
Quantity	Dick’s Sporting Goods	$25	$25.00	Amount Due
Quantity	GAP / Old Navy /BananaRepublic	$25	$25.00	Amount Due
Quantity	Home Depot	$50	$50.00	Amount Due
Quantity	J.C.Penney	$25	$25.00	Amount Due
Quantity	Kohl’s	$25	$25.00	Amount Due
Quantity	Kohl’s	$100	$100.00	Amount Due
Quantity	Macy’s	$25	$25.00	Amount Due
Quantity	Marshalls / TJ Maxx	$25	$25.00	Amount Due
Quantity	Target	$25	$25.00	Amount Due
Quantity	Walmart/Sam’s Club	$25	$25.00	Amount Due
Quantity	Walmart/Sam’s Club	$100	$100.00	Amount Due

Payment is due at pick-up of your order. Order Total: Total Amount Due Check# Check Number Cash Cash	Submit