COUPONS You must have JavaScript enabled to use this form. Name of Organization/Company * Contact Person * Contact Number(s) * Number of Coupon Booklets * 1 Booklet (25 coupons)2 Booklets (50 coupons)3 Booklets (75 coupons)4 Booklets (100 coupons)5 Booklets (125 coupons)6 Booklets (150 coupons)7 Booklets (175 coupons)8 Booklets (200 coupons)9 Booklets (225 coupons)10 Booklets (250 coupons)11 Booklets (275 coupons)12 Booklets (300 coupons)13 Booklets (325 coupons)14 Booklets (350 coupons)15 Booklets (375 coupons)16 Booklets (400 coupons)17 Booklets (425 coupons)18 Booklets (450 coupons)19 Booklets (475 coupons)20 Booklets (500 coupons) Email Address * Email Address, again * Location for Pick Up: (Location Information) * Hagåtña Branch Tumon Branch Dededo Branch Mangilao Branch Date of Pick Up Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202620272028 Time of Pick Up - Select Time-10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm01:00 pm01:30 pm02:00 pm02:30 pm03:00 pm03:30 pm04:00 pm04:30 pm05:00 pm05:30 pm06:00 pm06:30 pm07:00 pm07:30 pm08:00 pm08:30 pm09:00 pm You must agree to all the following by clicking the check boxes in order to submit this form: I have read, understand, and agree to conditions outlined in Jamaican Grill’s Fundraiser Coupons Terms & Conditions. * I have read, understand, and agree to conditions outlined in Jamaican Grill’s Fundraiser Coupons Terms & Conditions. I agree to render full payment upon pick-up of Fundraiser Coupons. Price per booklet is $150.00. * I agree to render full payment upon pick-up of Fundraiser Coupons. Price per booklet is $200.00. Should I need to cancel the order of plates, I will give at least forty-eight (48) hours notice call to the Jamaican Grill Office or to the designated restaurant of pick up if after Office hours. * Should I need to cancel the order of plates, I will give at least forty-eight (48) hours notice call to the Jamaican Grill Office or to the designated restaurant of pick up if after Office hours. Your Full Name *
