School Name*School Phone Number*School Address Street Address City State / Province / Region ZIP / Postal Code Your Name* First Last PhoneEmail* Phone*KickBack Card Number*Points to Donate*Remember each point is worth .01 cents. Confirm Points Donation*Would you like us to inform the school who made the donation?* Yes No (Remain Anonymous) Consent* I agree.I agree that the above information and points are mine to donate and give my consent to make a donation in my name or anonymous. I further agree if the points do not total the amount that I wish to donate Pete’s of Erie INC will notify me by email the amount that was donated. If the KickBack card number submitted is invalid, I give Pete’s of Erie INC permission to make attempts to contact me by any of the contact information I provided for the purpose of gathering corrected information only. If Pete’s of Erie INC is unable to contact me at the provided contact information, the requested donation will be terminated. Once submitted it may take up to 3 weeks to redeem your points and issue a check to the school that you choose.