Legacy National Dance Team
SHOP RITE GIFT CARD ORDER FORM
DANCER’S NAME: ________________________________
PARENT’S NAME: ________________________________
PHONE: _________________________________________
QTY Total $ Amt of Gift Card(s)
_______ @ $ 5.00 = $ ____________________________
_______ @ $ 10.00 = $ ____________________________
_______ @ $ 20.00 = $ ____________________________
_______ @ $ 25.00 = $ ____________________________
_______ @ $ 50.00 = $ ____________________________
_______ @ $ 100.00 = $ ____________________________
TOTAL ENCLOSED $ ______________________
5% of total cost will be deposited to above mentioned dancers account
Forms and checks will be collected by the 1st of each month
Make checks payable to
“Legacy”
For further information contact:
Debbie Young: jdalj21@comcast.net
908-391-0595: Cell or 908-284-0313: Home