$5000

100
8

28
PAC

2 Ms. Nemeth
Ms. Nemeth 800850 3003
30 JKC
JKC

Heather Atherton at atherton@shaw.ca

Michelle Kokan

mkokan@telus.net

** IGA BC IGA
$10-$500
4
**
2.5%

Southlands
Parent Name:_______________________________________(please print)
__________________________________________
Phone Number: _______________________________

_________________________________

Email:_______________________________________
_______________________________________
Name of Student:____________________________________

Grade:__________

______________________________________________

______________

Repeat my order monthly from October through June:________One time order only______
10 ____________

________

Please drop off my order at JKC______

JKC ______

SAVE ON FOODS (8%) (min $100) ________@ $______ each

$ __________

Stongs (8%) (min.$100)

________@ $______ each

$ __________

IGA (5%) Re-loadable **

________@ $50 each

$ __________

Shoppers Drug Mart (8%)

________@ $25 each

$ __________

Choices (5%) (any $)

________@ $______each

$ __________

Starbucks (5%)

________@ $10 each

$ __________

TOTAL MONTHLY AMOUNT:

Safeway (10 12 )

$_____________
________@ $______ each

$__________

Cheques enclosed_____________________________Payable to Southlands PAC

_____________________________ Southlands PAC
Visa/Mastercard #___________________________________________________
Expiry Date ____________________(if you change card numbers or expiry dates,
please be sure to update us)
___________________________________________________________________________
These gift cards must be paid for by cheque only:

Chevron (2%)

_________ @ $25 each

$__________

T & T Supermarkets (2%)

_________ @ $50 each

$ __________

Cheques enclosed______________________________Payable to Southlands PAC

______________________________ Southlands PAC