GROCERY CARD ORDER FORM

NCCL makes 5% on each card sold.

Please fill out the form below. Circle the dollar amount of cards that you would like from each store.

Put the order form and your check, made out to NCCL, in Bette’s box in the kitchen.

When the order is filled, Bette will send you an email. You can then pick up your cards from Bette’s box.

Name ____________________________________ Email_____________________________

ACME $100 $200 $300 $400 $500 $600 $700 $800 $900

PATHMARK $100 $200 $300 $400 $500 $600 $700 $800 $900

SHOPRITE $100 $200 $300 $400 $500 $600 $700 $800 $900

SUPERFRESH $100 $200 $300 $400 $500 $600 $700 $800 $900

Thank you for your order!

GROCERY CARD ORDER FORM

NCCL makes 5% on each card sold.

Please fill out the form below. Circle the dollar amount of cards that you would like from each store.

Put the order form and your check, made out to NCCL, in Bette’s box in the kitchen.

When the order is filled, Bette will send you an email. You can then pick up your cards from Bette’s box.

Name ____________________________________ Email______________________________

ACME $100 $200 $300 $400 $500 $600 $700 $800 $900

PATHMARK $100 $200 $300 $400 $500 $600 $700 $800 $900

SHOPRITE $100 $200 $300 $400 $500 $600 $700 $800 $900

SUPERFRESH $100 $200 $300 $400 $500 $600 $700 $800 $900

Thank you for your order!