| SCRIP ORDER FORM |
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NAME: |
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DATE: |
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PH # |
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RETURN IN THURS. ENVLP? |
YES NO |
| NEW HOPE CHRISTIAN SCHOOLS |
AMT REC'D: |
CHECK_____ |
| RC'D By: |
|
CASH_____ |
|
| OLIVE GARDEN IS OPEN IN MEDFORD! |
| BUY OLIVE GARDEN SCRIP/GIFT CARD |
| STORE
/ MERCHANT NAME |
AMT. |
% |
QTY. |
TOTAL |
| AUTOMOTIVE (Gas, Parts, Service) |
| EXXON |
$25, $50 |
2.50% |
|
|
| SHELL
PREPAID CARD |
$25, $50 |
2.00% |
|
|
| GROCERY STORES |
| GROCERY
OUTLET |
$5, $10 |
7.00% |
|
|
| PRICE
CHOPPPER |
Register thru eScrip
www.escrip.com |
| SAFEWAY |
$10, $20, $50, $100 |
3.00% |
|
|
| SPECIALTY ITEMS |
| BATH
& BODY WORKS |
$20 |
13.00% |
|
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| STARBUCKS
(MEDFORD) |
$25 |
7.00% |
|
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| SEE'S
CANDIES (MEDFORD) |
$12.40 lb. |
17.1% |
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| BOOK STORES & TOY STORES |
| BARNES
& NOBLE
|
$10, $25 |
8.00% |
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| BORDERS / WALDENBOOKS |
$10, $25 |
8.00% |
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| KB TOYS / KB TOY WORKS |
$10 |
9.00% |
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| TOYS 'R' US |
$10,$20 |
3.00% |
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| RESTAURANTS |
| APPLEBEE'S |
$20 |
8.00% |
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| BASKIN-ROBBINS |
$2 |
9.00% |
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| BURGER KING |
$5 |
3.60% |
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| CARL'S JR. |
$5 |
8.00% |
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| |
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|
| <<<<<<< MORE ON BACK
>>>>>> |
| STORE / MERCHANT |
AMT. |
% |
QTY. |
TOTAL |
| DENNY'S RESTAURANTS |
$5 |
8.00% |
|
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| DOMINO'S
PIZZA |
$5 |
4.00% |
|
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| HONEY
BAKED HAMS |
$25 |
9.00% |
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| KENTUCKY
FRIED CHICKEN |
$5 |
8.00% |
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| MARIE
CALLENDERS |
$20 |
10.00% |
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| OLIVE GARDEN / RED LOBSTER |
$10 |
13.00% |
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| OUTBACK
STEAKHOUSE |
$25 |
3.00% |
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| PIZZA
HUT |
$5, $10 |
9.00% |
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| PRETZEL TIME |
$10 |
20.00% |
|
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| RED
ROBIN |
$10 |
11.00% |
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| TCBY
(NEXT TO SAFEWAY) |
$5 |
20.00% |
|
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| WENDY'S |
$10 |
7.00% |
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| VIDEO / ELECTRONICS / HARDWARE/ OFFICE SUPPLIES |
| ACE
HARDWARE |
$25 |
7.00% |
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| BLOCKBUSTER VIDEO |
$10 |
7.00% |
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| CIRCUIT CITY CARD |
$25, $50, $100 |
2.50% |
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| EAGLE/LOWES |
$25 $50 $100 |
2.00% |
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| HOLLYWOOD VIDEO (RENTAL &
MERCHANDISE) |
$5 |
15.00% |
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| RADIO
SHACK |
$25 |
4.00% |
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| STAPLES |
$25 |
4.00% |
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| CLOTHING / SHOES, DISCOUNT STORES, ETC. |
| BIG 5 SPORTING
GOODS |
$10, $25 |
8.00% |
|
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| BIG DOG
SPORTSWEAR |
$15 |
20.00% |
|
|
| FACTORY
2-U |
$10, $25 |
3.00% |
temporarily not available |
|
| FOOT
LOCKER |
$25, $50 |
13.00% |
|
|
| GAP |
$20 |
8.00% |
|
|
| OLD NAVY |
$20 |
8.00% |
|
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| PAYLESS
SHOE SOURCE |
$10 |
12.00% |
|
|
| ROSS
DRESS FOR LESS |
$10 |
8.00% |
|
|
| T.J.MAXX
/ MARSHALLS |
$10, $25 |
8.00% |
|
|
| DEPARTMENT / SPECIALTY STORES |
| GOTTSCHALK'S |
$10, $25, $100 |
7.00% |
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| JCPENNEY |
$25,$100 |
5.00% |
|
|
| SEARS (No pymt on
acct) |
$25, $100, $250 |
2.00% |
|
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| PIER 1
IMPORTS (No pymt.on acct.) |
$10 |
7.00% |
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| EDDIE
BAUER |
$20 |
9.00% |
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| CARNIVAL
CRUISE LINES |
$25 $100 |
10.00% |
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| TOTAL
SCRIP ORDER |
$ |
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