Is this an order for a friend, neighbor, co-worker, or family member? / What’s their name:
Youngest Child’s Name: / Total Number of Cards Ordered:
Youngest Child’s Teacher: Grade: / ***PLEASE MAKE CHECKS PAYABLE TO MILL RUN PTO***
Address: / Total Amount: Check Number:
Email: / PTO USE: ( )pmt ( )Entered ( )Audited
Please feel free to make copies of this form for friends, neighbors, and relatives!
Have Questions? Want a national gift card that you don’t see on Page 2? Contact:
*** LOCAL VENDORS ***
Support Local Business Owners AND Mill Run PTO!
VENDOR / % / Qty / $Price / Total / VENDOR / % / Qty / $Price / Total
All American Steakhouse $25 / 50% / 25.00 / Parallel Wine Bistro $25 / 20% / 25.00
All American Steakhouse $50 / 50% / 50.00 / Parallel Wine Bistro $50 / 20% / 50.00
BlackFinn Ameripub $25 / 20% / 25.00 / Passion Fin $25 / 20% / 25.00
BlackFinn Ameripub $50 / 20% / 50.00 / Passion Fin $50 / 20% / 50.00
Blend Coffee Bar $10 / 15% / 10.00 / Radiance Salon $25 / 15% / 25.00
Blend Coffee Bar $20 / 15% / 20.00 / Radiance Salon $50 / 15% / 50.00
Blue Ridge Grill $25 / 20% / 25.00 / Rubino’s $25 / 15% / 25.00
Blue Ridge Grill $50 / 20% / 50.00 / Sweet & Sassy $25 / 20% / 25.00
Broadlands Pizza $25 / 20% / 25.00 / Sweet & Sassy $50 / 20% / 50.00
Burger 21 $25 / 15% / 25.00 / The Zone $20 / 20% / 20.00
Burger 21 $50 / 15% / 50.00 / The Zone $50 / 20% / 50.00
Café Opera $20 (Dine-In only, no coupons*) / 20% / 20.00 / The Zone $100 / 20% / 100.00
Clyde’s $25 / 15% / 25.00 / Zinga $5 / 20% / 5.00
Clyde’s $50 / 15% / 50.00 / Zinga $10 / 20% / 10.00
Zinga $25 / 20% / 25.00
Total
No. / # / Total
Amt. / $
Ex: You buy a $25.00 Blue Ridge Grill Gift Card… you receive the full $25.00 and Blue Ridge donates $5.00 to Mill Run!
FINAL DUE DATE: TUESDAY, NOVEMBER 28th Forms must be in NO LATER than 3 PM
MILL RUN ELEMENTARY FALL 2017 GIFT CARDS
EARLY BIRD DUE DATE: THURSDAY, NOVEMBER 16th
FINAL DUE DATE: TUESDAY, NOVEMBER 28th Forms must be in NO LATER than 3 PM