Pride of the Dutchmen Smart Shopping Order Form 
Name:_____________________ Check #:_________
Date:______________________ Cash:___________
Business Options Amount
Hardees $5               
Pizza Hut $5               
Pizza Ranch $1, $5 or $10               
Subway $20 ______
Szechuan Inn $10               
Taco John's $1               
Nederlander's Grill $10               
Jansen's $25, $50, $100               
Bomgaars $25,$50,$100,$200               
Hannah's Hallmark $25 debit cards               
Mulder Oil $25, $50, $100, or $500 cards               
Lewis Family Drug $20 or $50 ______
A8 $10 ______
Total____________________________________________________________
Checks should be made out to POD Band Parents
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Business % Purchase Guidelines
Hardees 10% Only Orange City, Sioux Center, 
Pizza Hut 8% None
Pizza Ranch 10% Only Orange City, Sioux Center, LeMars
(no change given)
Subway 12% Orange City & Sioux Center
Szechuan Inn 10% No change given
Taco John's 20% Only Orange City & Sioux Center
Nederlander's Grill 10% No change given
Jansen's 3% None
Bomgaars 5% Can be used at any Bomgaars
Hannah's Hallmark 4% Includes Photo Center, no sale items
Mulder Oil/Sinclair/Dutch Mart 4%
Lewis Family Drug 5% All locations, anything in store including
prescriptions
A8 5% Orange City only