STOP & SHOP, SHAWS, & DAVE’S GIFT CERTIFICATES



|Name: | |Phone #: | |Email: | |

|Please return the completed form with payment in full to: |NOTE: Cash, Check or Money Orders are acceptable. |

|Temple Sinai |Please make checks payable to: |

|Attn: Gift card Program |Temple Sinai |

| |

|Store Card Denominations Qty $ Amount |

|Dave’s Marketplace |___# of cards @ $25 | ___# of cards @ $50 | ___# of cards @ $100 | | |

|Stop & Shop |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Shaw’s |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Aeropostale |___# of cards @ $25 |___# of cards @ $25 |___# of cards @ $100 | | |

|AMC/Lowes Theaters |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|American Eagle |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Applebees |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Babies R Us |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Barnes & Noble |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Bass Pro |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Bath & Body Works |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Bed Bath & Beyond |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Best Buy |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Cabelas |___# of cards @ $15 |___# of cards @ $50 | | | |

|Cheesecake Factory |___# of cards @ $45 | | | | |

|Chili's | |___# of cards @ $50 | | | |

|Coldstone | |___# of cards @ $30 | | | |

|Cracker Barrel |___# of cards @ $25 | | | | |

|Disney |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|DSW |___# of cards @ $25 |___# of cards @ $50 | | | |

|Dunkin Donuts |___# of cards @ $15 |___# of cards @ $25 | | | |

|Express |___# of cards @ $15 |___# of cards @ $50 |___# of cards @ $100 | | |

|Forever 21 |___# of cards @ $25 |___# of cards @ $50 | | | |

|Fridays |___# of cards @ $25 |___# of cards @ $50 | | | |

|Gap |___# of cards @ $25 | - | | | |

|Home Depot |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|iTunes |___# of cards @ $15 |___# of cards @ $25 |___# of cards @ $50 | | |

|JC Penney |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Justice |___# of cards @ $25 | | | | |

|Kohls |___# of cards @ $25 |___# of cards @ $50 | | | |

|Lowes |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Macy's |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|McDonalds |___# of cards @ $15 |___# of cards @ $25 | | | |

|Nike |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Ocean State Job Lot | |___# of cards @ $50 | | | |

|Old Navy |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Olive Garden |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Outback |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Panera |___# of cards @ $25 |___# of cards @ $50 | | | |

|PF Chang's |___# of cards @ $25 |___# of cards @ $50 | | | |

|Pottery Barn | |___# of cards @ $50 | | | |

|Red Lobster |___# of cards @ $25 |___# of cards @ $50 | | | |

|Sears |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Shell | |___# of cards @ $50 | | | |

|Southwest Air or Marriott |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|(circle which one) | | | | | |

|Staples |___# of cards @ $25 |___# of cards @ $50 |___# of cards @ $100 | | |

|Starbucks |___# of cards @ $25 |___# of cards @ $50 | | | |

|Subway |___# of cards @ $30 | | | | |

| Sephora |___# of cards @ $25 |___# of cards @ $50 | | | |

|Talbots | |___# of cards @ $50 | | | |

|TGI Friday's |___# of cards @ $25 |___# of cards @ $50 | | | |

|Toys R Us |___# of cards @ $25 | | | | |

| | | | | | |

|Total of Gift Cards Ordered | |

|Total Amount Due |$ |

| Please indicate your choice of pick-up by checking one of the following: |

|I will pick up my cards in the front office. |

| |

|Please send home with my child (name)___________________Teacher and room #_______________ |

| |

|Signed_____________________________________ Date________________________________ |

|______I waive any responsibility of loss or damage. (Must be checked or cards will not be released to the student) |

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