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VOKRA Supporter Order Form - revised NOV 2011-2-1

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VOKRA Supporter Order Form - revised NOV 2011-2-1 Powered By Docstoc
					                                                                                 VOKRA SUPPORTER ORDER FORM
                                                                                   Thank You For Your Support!
                                         Vendor                                                                          Vendor
Grocery Stores                          Donation   0                    $   -    Specialty Stores:                      Donation   0                       $       -
MarketPlace IGA                                                                  Options
*** Reloadable***                       5.0%           x $      50.00   $   -    (Gap, Old Navy, Banana Republic)        7.0%          x $         25.00   $       -
                                                                                 Options
Choices Market                          7.0%           x   $ 20.00      $   -    (Gap, Old Navy, Banana Republic)        7.0%          x   $ 50.00         $       -
Choices Market                          7.0%           x   $ 100.00     $   -    Staples                                 3.0%          x   $ 25.00         $       -
Choices Market                          7.0%           x   $ 250.00     $   -    Staples                                 3.0%          x   $ 50.00         $       -
Killarney Market                        3.0%           x   $ 25.00      $   -    Staples                                 3.0%          x   $ 100.00        $       -
Loblaws (No Frills, Superstore, Extra
Foods)                                  3.0%           x   $    25.00   $   -    Staples                                 3.0%          x   $ 250.00        $       -
Loblaws                                 3.0%           x   $    50.00   $   -    Starbucks                               5.0%          x   $ 10.00         $       -
Loblaws                                 3.0%           x   $   100.00   $   -    Starbucks                               5.0%          x   $ 25.00         $       -
Loblaws                                 3.0%           x   $   250.00   $   -    Starbucks                               5.0%          x   $ 50.00         $       -
Safeway                                 3.0%           x   $    50.00   $   -    Toys 'R' Us                             2.0%          x   $ 25.00         $       -
Safeway                                 3.0%           x   $   100.00   $   -    Winners                                 7.0%          x   $ 25.00         $       -
Safeway                                 3.0%           x   $   250.00   $   -    Winners                                 7.0%          x   $ 50.00         $       -
Stong's                                 6.0%           x   $    50.00   $   -    Aldo                                    7.0%          x   $ 25.00         $       -
Stong's                                 6.0%           x   $   100.00   $   -    American Eagle                          5.0%          x   $ 25.00         $       -
Stong's                                 6.0%           x   $   500.00   $   -    Best Buy                                2.0%          x   $ 25.00         $       -
                                                                                 Best Buy                                2.0%          x   $ 50.00         $       -
                                         Vendor
Department Stores                       Donation   0                    $   -    Best Buy                               2.0%           x   $ 100.00        $       -
HBC (Bay, Zellers, Home Outfitters)      3.0%          x   $ 25.00      $    -   Canadian Tire                          3.0%           x   $ 25.00         $       -
HBC (Bay, Zellers, Home Outfitters)      3.0%          x   $ 100.00     $    -   Canadian Tire                          3.0%           x   $ 50.00         $       -
London Drugs                             2.0%          x   $ 25.00      $    -   Canadian Tire                          3.0%           x   $ 100.00        $       -
London Drugs                             2.0%          x   $ 50.00      $    -   Chapters/Indigo/Coles                  10.0%          x   $ 20.00         $       -
London Drugs                             2.0%          x   $ 100.00     $    -   Esquires Coffee                        10.0%          x   $ 25.00         $       -
Sears (reloadable)                       2.0%          x   $ 25.00      $    -   Future Shop                            2.0%           x   $ 50.00         $       -
                                         Vendor
Home Improvement:                       Donation   0                    $   -    Future Shop                             2.0%          x   $ 100.00        $       -
Home Depot                               2.0%          x   $ 50.00      $    -   La Senza                                7.0%          x   $ 25.00         $       -
Home Depot                               2.0%          x   $ 100.00     $    -   M&M Meat Shops                          3.0%          x   $ 25.00         $       -
Home Hardware                            3.0%          x   $ 50.00      $    -   Mark's Work Wearhouse                   7.0%          x   $ 25.00         $       -
Home Hardware                            3.0%          x   $ 100.00     $    -   Mark's Work Wearhouse                   7.0%          x   $ 50.00         $       -
Rona                                     3.0%          x   $ 50.00      $    -   Mark's Work Wearhouse                   7.0%          x   $ 100.00        $       -
Rona                                     3.0%          x   $ 100.00     $    -   Payless Shoe Source                     5.0%          x   $ 25.00         $       -
                                                                                 Shoppers Drug Mart                      3.0%          x   $ 25.00         $       -
                                         Vendor
Fuel:                                   Donation   0                    $   -    Shoppers Drug Mart                      3.0%          x $         50.00   $       -
Esso (reloadable)                        2.0%          x $      25.00   $    -   Sport Chek                              4.0%          x $         25.00   $       -
                                                                                                                         Vendor
Esso (reloadable)                       2.0%           x   $ 50.00      $   -    Restaurants:                           Donation   0                       $       -
Esso (reloadable)                       2.0%           x   $ 100.00     $   -    Boathouse                               7.0%          x   $       25.00   $        -
Petro-Canada                            2.0%           x   $ 50.00      $   -    Boathouse                               7.0%          x   $       50.00   $        -
Petro-Canada                            2.0%           x   $ 100.00     $   -    Boston Pizza                            7.0%          x   $       25.00   $        -
Chevron                                 2.0%           x   $ 25.00      $   -    Cactus Club                             7.0%          x   $       25.00   $        -
                                                                                 Cactus Club                             7.0%          x   $       50.00   $        -
                                         Vendor
Entertainment:                          Donation   0                    $   -    Domino's                                8.0%          x $         25.00   $       -
                                                                                 Earls                                   7.0%          x $         25.00   $       -
Rogers Video                            7.0%           x $      20.00   $   -    Earls                                   7.0%          x $         50.00   $       -
Cineplex Odeon (Famous Players,
Galaxy, SilverCity, Colossus,
Paramount)                              5.0%           x $      10.00   $   -    Keg                                    7.0%           x   $       25.00   $       -
                                                                                 Keg                                    7.0%           x   $       50.00   $       -
                                                                                 Moxie's                                10.0%          x   $       25.00   $       -
                                                                                 Old Spaghetti Factory                  5.0%           x   $       25.00   $       -
                                         Vendor                                  Kelsey's Multi (Milestones, Swiss
Spas:                                   Donation   0                    $   -    Chalet)                                 3.0%          x $         25.00   $       -
                                                                                 Kelsey's Multi (Milestones, Swiss
WaySpa                                  10.0%          x   $ 50.00      $   -    Chalet)                                3.0%           x   $       50.00   $       -
WaySpa                                  10.0%          x   $ 100.00     $   -    Red Robin                              7.0%           x   $       25.00   $       -
Spa Utopia - www.spautopia.ca           7.0%           x   $ 50.00      $   -    Sammy J Peppers                        10.0%          x   $       25.00   $       -
Spa Utopia - www.spautopia.ca           7.0%           x   $ 100.00     $   -    Subway                                 5.0%           x   $       10.00   $       -
                                                                                 Subway                                 5.0%           x   $       25.00   $       -
                                         Vendor
Hotel & Accommodation:                  Donation   0                    $   -    Triple O's                              7.0%          x $         25.00   $       -
Fairmont Hotels                         10.0%          x $ 100.00       $    -   White Spot                              7.0%          x $         25.00   $       -



DATE:                                                                            TOTAL # OF GIFT CARDS                                                     0
NAME OF SUPPORTER:                                                               TOTAL ORDER                                                   $               -
ADDRESS:                                                                         PLEASE MAIL ORDER WITH CHEQUE TO:
CITY, PROVINCE:                                                                  GIFT CARDS,VOKRA, POBOX 74571,
POSTAL CODE:                                                                     2768 West Broadway,VANCOUVER BC Canada,V6K 4P4
PHONE NO:                                                                        PLEASE INCLUDE $2 FOR POSTAGE & HANDLING
EMAIL:                                                                           QUESTIONS? EMAIL: vokragiftcards@gmail.com

IF YOU WOULD LIKE TO MAKE THIS A STANDING                                        THANK YOU FOR YOUR ORDER AND SUPPORT !
MONTHLY ORDER, PLEASE INCLUDE POST DATED CHEQUES.                                VENDOR DONATION                      $                                            -

         7/22/2012 1:36 AM                                                                         cd213def-3597-4b37-9b1a-0c92a5e45d9e.xls rvsd Sept 2011

				
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