During the past month, how much have you spent in:

Grocery?

(i.e. Chips, Candy, Snacks, Refrigerated & Frozen Items, Canned Goods, Pantry Staples, Beverages, Fresh Meat, Produce, Gourmet Foods)

Paper Products?

(i.e. Paper Towels, Bath Tissue, Facial Tissue, Paper Plates, Paper Cups)

Office Supplies?

(i.e. Writing instruments, Paper Clips, Pads, Notebooks, Planners)

Electronics?

(i.e. Computers, Printers, TVs, iPods)

Baby Care?

(i.e. Diapers, Wipes, Formula, Baby Food, Car Seats)

Over-the-Counter Pharmacy?

(i.e. Non-Prescription Drugs and Remedies)

Personal Care (HBA)?

(i.e. Shaving Needs, Dental Care, Hair Care)

Laundry and Cleaning?

(i.e. Fabric Softener, Detergent, Disinfectant Spray & Wipes)

Pet Supplies?

(i.e. Food, Treats, Beds, Toys)

Based on your personal spending, your annual potential savings as a Sam’s Club Member could be $_______ ***

***The estimated savings total listed is based on the shopping information provided by the Challenge participant. Based on estimated annualized savings of select Sam’s Club Members on items Members purchased in select categories derived from a survey conducted in 30 U.S. markets between 07/27/2009 and 08/24/2009 comparing our regular unit prices to regular unit prices of selected non-Club competitors, including, but not limited to, grocery stores and mass retailers. Local savings for individual customers vary. For more information, please send request to the attention of Sam’s Club Member Services, 608 S.W. 8th St., Bentonville, AR 72716-0745.