Saint Dorothy – Dot’s Dollars Program Date:

Name: ______Phone #: ______

Address: ______

Please make check payable to Saint Dorothy H & S

Stores / Amount / Discount / Denomination / # of cards / Dollar Amount
Barnes & Noble Bookstores / $10 / 9%
Bath & Body Works / $10 / 13%
Bed, Bath & Beyond / $25 / 7%
Claire's / $10 / 9%
CVS / $25 / 6%
Dick's Sporting Goods / $25 / 8%
Game Stop/ EB Games / $25 / 3%
Gap Tri-Card(Banana Republic, Old Navy, & Gap) / $25 / 9%
Giant Foods / $25 / 4%
Great Clips / $25 / 8%
Home Depot / $25 / 4%
Kohl's / $10/25/50/100 / 5%
Lowes Home Improvement / $25 / 4%
Payless / $20 / 13%
Rite Aid / $25 / 4%
Staples / $25 / 5%
The Children's Place / $25 / 12%
Target / $25 / 2%
TJ Maxx/ Home Goods/ Marshalls / $25 / 7%
Toys/Kids/Babies-R-Us / 20 / 1.5%
Wal-Mart / $25 / 2%
Wawa / $25 / 1.5%
Restaurants
Dunkin Donuts / $10 / 4%
Panera Bread / $10 / 9%
Outback/Bonefish / $25 / 8%
Rita's / $5 / 10%
Starbucks / $10 / 7%
Subway / $10 / 3%
Swiss Farms / $25 / 5%
Tony Roni's / $10 / 10%
Wendy's / $10 / 4%
Other Services
AMC Theaters / $25 / 7%
AMC Single Ticket / $9.50 / 16%
Regal Single Ticket / $9.50 / 15%
TOTAL ORDER

Cash ______Check # ______