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VaHomeschoolers Box Tops For Education Submission Form

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VaHomeschoolers Box Tops For Education Submission Form Powered By Docstoc
					VaHomeschoolers Box Tops For Education Submission Form

Instructions:
If you want to donate the full value of your Box Tops for Education coupons to VaHomeschoolers,
just mail them in to the address below, in bundles of 50. No form necessary.

If you would like reimbursement for half the value of your Box Tops for Education coupons, fill out
both parts of this form. Following the instructions at www.vhea.org/boxtops.html , mail this form with your
coupons* (in bundles of 50) and SASE to: BoxTops, VaHomeschoolers, P.O. Box 5131, Charlottesville,
VA 22905



(This portion is for our Box Tops for Education coordinator)

Date: _____________________

Name:________________________________________________________________

Address: _____________________________________________________________

Phone:________________________ e-mail: __________________________________

Group name:___________________________________________________________

Reimbursement of 50% requested. Please make check out to: ______________________

Total number of coupons submitted* ______ x .05 = ______



(This portion is for our Treasurer, for bookkeeping/checkwriting purposes)

Date: _____________________

Name:________________________________________________________________

Address: _____________________________________________________________

Phone:________________________ e-mail: __________________________________

Group name:___________________________________________________________

Reimbursement of 50% requested. Please make check out to: ______________________

Total number of coupons submitted* ______ x .05 = ______



*Minimum of 200 coupons required for reimbursement.

				
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