Boscov's Shopping Pass - Order Form
Receive a Boscov's Friends Helping Friends Shopping Pass valid for Wednesday, October 19, 2022 for a donation of $5 .  After you have completed the form, click the "SUBMIT" button at the end of the form.  After you submit the form, you will receive a confirmation email at the email address you submit below.  Instructions for making your payment will be included in that email.  Please order by October 9, 2022.

***IT IS IMPORTANT THAT YOU CLICK THE SUBMIT BUTTON AT THE END OF THE FORM***
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Email *
Your Information
Please complete all sections.
First Name: *
Last Name: *
Street Address: *
City: *
State: *
Zip: *
Number of Boscov's Shopping Passes? (Each Shopping Pass is $5) *
Total $ amount owed: (Number of Shopping Passes x 5 - FYI: PayPal requires additional .50 per Shopping Pass for processing. See below.)  Any additional donation to cover postage would be greatly appreciated. *
How are you paying? *
Please indicate how you will be sending payment.  Shopping Passes will ship as soon as payment is received.  See directions below.  Any additional donation to cover postage would be greatly appreciated.
Payment Directions
To pay via PayPal/Credit Card, Please click here: https://www.cockeradoptions.org/donations.html
To pay via check/money order, Please make the check out to CSAC.
Any additional donation to cover postage would be greatly appreciated.
Mail payment to:
CSAC Shopping Pass
C/O Patricia King, Treasurer
618 James Dr.,
Rostraver Twp, PA 15012-4742
Questions may be sent to: finance@cockeradoptions.org
A copy of your responses will be emailed to the address you provided.
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