Seller/Student _________________________________
Student Home Phone: _________________
Buyer Name: ______________________________________ (if you have multiple buyers, you may use additional forms or combine your orders on one form.)
GIFT CARDS ORDERED:
____ @ $25 = $_______
____ @ $50 = $_______
____ @ $100 = $_______
Total number of cards:
SOOPERS
____ @ $25 = $_______
Initial card is $25 & after that you may put addt’l funds on the
Card at King Soopers.
SUNFLOWER
____ @ $10 = $______
____ @ $25 = $_______
____ @ $50 = $_______
Safeway ____ King Soopers ____ Sunflower ____
Total dollar amount:
Safeway $________ King Soopers $________ Sunflower $________
TOTAL $ COLLECTED $
**You can now charge your grocery card orders through Laura Wile (bookkeeper) in the FCHS Front Office.
Please attach your pink charge receipt to this order form before turning it into the music office**
Checks should be made payable to “FCHS: Grocery Certificates” (no cash please).
Order Due Dates
Sept. 9, 2011
Oct. 7, 2011
Distribution Dates
Sept. 16, 2011
Oct. 14, 2011
May 4, 2012 May 11, 2012
Details: Please submit your order by 3:00 p.m. on the due date.
Students may turn in the orders to their music teachers or to the music department office. Please tally the total number of Safeway, King Soopers and Sunflower grocery cards, the dollar amounts and the order total in dollars.
Additional order forms can be found in the music rehearsal rooms and online at the FCHS website under the Music
Department link. http://staffweb.psdschools.org/dmiles/index.html
Grocery gift cards will be distributed in class and sent home with the students on the distribution dates.
Through this fundraiser, we will receive a 3% to 5% return from Safeway, depending on the amount of gift cards sold and a 5% return on all King Soopers and Sunflower totals. The proceeds will be deposited into the Music Department’s account and be used for it’s 2011-12 goals. Please check the website for more details and updates.
Questions? Please contact Debbie Silar, Grocery Card Coordinator, at Dsilar@aol.com
or 222-4930.
Thanks so much for your help and participation!
Revised 07/27/11