ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

ClubBucks Proof Of Purchase

Merchant Affiliate ID/Cashier: ____________

Amount_____________

ClubBucks Transaction Date: _______________

If your cash register is not able to print the ClubBucks Rewards Number on the receipt, you can have your staff write the ClubBucks Rewards Card number and their name on the receipt instead of using this form. Example: CB12345 ABC