PRINT AND USE THIS FORM WHEN PURCHASING FROM A VENDOR IN THE PROGRAM.
When you have chosen the item or service you wish to purchase,
PRINT THIS FORM and present it to the Parish Rewards partner.
NOTE: Some companies have purchase requirements.
Consult the individual company's ad and terms for details.
Present the form at time of purchase or contract signing.
Vendors are not required to honor the form if you wait until after purchase.
Parish Rewards Program Form
[CUSTOMER TO COMPLETE THIS SECTION]
Customer Name: ______________________________________________________
Address: __________________________________________________________________
City: ____________________ State: ______ Zip: _______ Phone:__________________
Please credit 50% of vendor contribution to one of the six (6) following options:
Family name:_____________________________________________________
(1a) __ Tuition – St. Vincent’s School (1b) __ Tuition – Bishop Dwenger High School (1c) ___ College Tuition __________ __ Current student OR __ Future student
STUDENT NAME________________________ ____________________________
(3) __ School Fund __ (4) General Tuition Assistance __ (5) Church Fund __ (6) __ Religious Education (Student Name_______________)
[VENDOR TO COMPLETE THIS SECTION]
Vendor Name: __________________________________________________ Contact Person: _____________________ Date of purchase: ___________ Amount of contribution to St. Vincent’s: ___________________
Please make three copies of this form – (2) copies are for the purchaser, (1) for vendor.
Keep original for your records. Mail copy with check to:
St. Vincent’s School, Attn: Advancement Office, 1720 E. Wallen Rd. Ft. Wayne, IN 46825
PURCHASER: Please keep one copy for your records, Mail other copy to the address above
OR email the completed form to reginazedaker@saintv.org