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| Home Scrip Card Order Form |
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| Questions? Please call: Tonya Lange at |
TRINITY LUTHERAN SCHOOL |
More Retailers online@ |
| 856-4079 |
SCRIP ORDER FORM |
http://www.glscrip.com |
| Name |
Phone |
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E-mail |
Date |
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| Retailer |
Card Value |
Qty |
Cost |
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Retailer |
Card Value |
Qty |
Cost |
| (circle one) |
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(circle one) |
| LOCAL |
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DINING/FOOD |
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| 675 Minute Total Access (15%) |
$20 |
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Applebee's (8%) |
$25/$50 |
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| AT&T 120 Min. Card (20%) |
$9.50 |
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Chili's (11%) |
$25 |
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| Ace Hardware (4%) |
$25/$100 |
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Chuck E. Cheese (8%) |
$10 |
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| Best Western (12%) |
$25/$100 |
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Country Buffet (5%) |
$25 |
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| Blockbuster (7%) |
$10 |
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Cracker Barrel (9%) |
$10 |
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| Burger King (4%) |
$10 |
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Denny's (7%) |
$10 |
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| Checker Auto Parts (8%) |
$25 |
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Olive Garden (9%) |
$25 |
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| Comfort Inn (6%) |
$25/$100 |
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Red Lobster (9%) |
$25 |
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| Domino's Pizza (5%) |
$5 |
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Outback Steakhouse (5%) |
$25 |
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| Exxon/Mobile (1.5%) |
$50 |
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Baskins Robbins (9%) |
$2 |
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| KFC (9%) |
$5 |
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TGI Friday's (9%) |
$25 |
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| K-Mart (4%) |
$25/$50 |
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| Pizza Hut (8%) |
$10 |
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Starbucks (7%) |
$10/$25 |
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| Radio Shack (4%) |
$25 |
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| Safeway (4%) |
$25/$100 |
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See's Candies (25%) |
$15.00 |
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| Sears (4%) |
$25/$100/$250 |
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Harry & David (10%) |
$25 |
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| Shell (1.5%) |
$25/$50/$100 |
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Panera Bread (9%) |
$10 |
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| Subway (3%) |
$10/$50 |
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BOOKS/CRAFTS/MISC. |
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| Smart Style @ Wal-Mart (8%) |
$25 |
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B. Dalton Books (9%) |
$10/$25/$100 |
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Barnes and Noble (9%) |
$10/$25/$100 |
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| Walgreen's (2%) |
$25/$100 |
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Borders (9%) |
$10/$25 |
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| Walmart (2%) |
$25/$100/$250 |
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Waldenbooks (9%) |
$10/$25 |
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| Wendy's (4%) |
$10 |
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Amazon.com (4%) |
$25/$100 |
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| SPORTS/HUNTING |
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GNC (8%) |
$25 |
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| Cabela's (11%) |
$25/$100 |
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JoAnn Fabrics (6%) |
$20 |
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iTunes (4%) |
$15 |
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TOYS/KIDS |
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| CLOTHING/SHOES |
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KB Toys (4%) |
$20 |
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| Eddie Bauer (9%) |
$25 |
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Kids, Toys, Babies R' Us (1.5%) |
$20 |
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| Foot Locker Stores (9%) |
$25 |
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| Gap (Gap Tri-Card) (9%) |
$25 |
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HOME/HOME DECOR |
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| Old Navy (Gap Tri-Card) (9%) |
$25 |
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Bath & Body Works (13%) |
$10/$25 |
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| L.L. Bean (15%) |
$25/$100 |
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| Lands End(17% until 12/08) |
$25/$100 |
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Bed, Bath, & Beyond (7%) |
$25 |
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| T.J. Maxx (Tri-Card) (7%) |
$25/$100 |
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Pier 1 Imports (9%) |
$25 |
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| Maurices (7%) |
$20 |
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Menard's Home Centers (3%) |
$25/$100 |
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| Payless Shoes (13%) |
$20 |
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Home Depot (4%) |
$25/$100/$500 |
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| Ross (8%) |
$25 |
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Lowe's Home Improvement(4%) |
25/100/500/1000 |
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| Dillard's (9%) |
$25/$100 |
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TRAVEL/GAS |
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| Kohl's (4%) |
$25/$100 |
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BP Gas (2%) |
$50/$100 |
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| JCPenny's (5%) |
$25/$100 |
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BP Gas (3%) |
$250 |
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| Herberger's (8%) |
$25/$100 |
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Chevron (2%) |
$50/$100 |
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| Shopko (4%) |
$25/$50 |
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Chevron (3%) |
$250 |
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| Claire's (9%) |
$10 |
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Sinclair's (2%) |
$25/$100 |
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| Macy's (10%) |
$25/$100 |
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Hyatt Hotel's (9%) |
$25/$100 |
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| OFFICE SUPPLIES |
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Quality Inn (6%) |
$25/$100 |
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| Best Buy (3%) |
$25/$100/$250 |
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American Airlines (8%) |
$100/$250 |
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Carnival Cruises (8%) |
$100 |
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| Office Max (5%) |
$25 |
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Disney Gift Card (2%) |
25/$100/1000 |
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| Staples (5%) |
$25/$100 |
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Marroitt (12%) |
50/$100/500 |
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| Order Total: |
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Cash/Check #: |
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