By mentioning Sarah Adams Elementary School
January 29th – February 2nd Domino’s Pizza® will gladly
donate 20% of your order back to your school!
Includes Super Bowl Sunday!
*Maximum donation allowed can be: Up to $500.00
Thousands raised for our local schools!
Lake Zurich
890 S Rand Rd
(847)796-3300
DOMINO’S® PIZZA PURCHASE FORM
IMPORTANT: Remember, you must mention the school name in order for 20% of the price to be donated. Give completed form to the delivery driver or
turn in when picking up order.
Call your local Domino’s® to place your order.
School: Sarah Adams Elementary School
Student’s Name:
Home Room Teacher:
Total Price of Order:
Order Number: