SCRIP Order Form
Greenbrook Eagle Fund
Please order carefully…all sales are final (no returns or exchanges)!
All orders are SPECIAL ORDERS!!! SCRIP goes monthly! See Eagle website for order/delivery dates! Visit www.glscrip.com for additional retailers.
|
Child’s FIRST Name
|
_________________________ |
Teacher/Grade |
____________________ |
|
Child’s LAST Name
|
_________________________ |
Check Amount |
____________________ |
|
Daytime Phone# |
_________________________ |
Today’s Date |
______/______/ 09 |
|
Merchants |
% |
Quantity |
Card Value |
Quantity |
Card Value |
Total |
|
Amazon.com |
4% |
|
$25 |
|
$100 |
$ |
|
Applebees |
8% |
|
$25 |
|
$50 |
$ |
|
Arco |
2% |
|
$50 |
|
|
$ |
|
Baja Fresh |
7% |
|
$25 |
|
|
$ |
|
Barnes & Noble/B. Dalton |
9% |
|
$10 |
|
$25 |
$ |
|
Baskin Robbins |
9% |
|
$2 |
|
|
$ |
|
Bath & Body Works |
13% |
|
$10 |
|
$25 |
$ |
|
Bed Bath & Beyond |
7% |
|
$25 |
|
|
$ |
|
Best Buy |
3% |
|
$25 |
|
$100 |
$ |
|
Big 5 Sporting Goods |
8% |
|
$25 |
|
|
$ |
|
Blockbuster |
7% |
|
$10 |
|
|
$ |
|
Blockbuster- 1 movie rental |
15% |
|
$3.79 |
|
|
$ |
|
Borders/Waldenbooks |
9% |
|
$10 |
|
$25 |
$ |
|
Build-A-Bear Workshop |
8% |
|
$25 |
|
|
$ |
|
Burger King |
4% |
|
$10 |
|
|
$ |
|
California Pizza Kitchen |
4% |
|
$10 |
|
|
$ |
|
Cheesecake Factory |
5% |
|
$25 |
|
|
$ |
|
Chevron |
1.5% |
|
$50 |
|
|
$ |
|
Chevy’s Restaurant |
8% |
|
$25 |
|
|
$ |
|
Chilis/Macaroni Grill |
11% |
|
$25 |
|
|
$ |
|
Chipotle Mexican Grill |
10% |
|
$10 |
|
|
$ |
|
Cinemark/Century Theaters |
4% |
|
$25 |
|
|
$ |
|
Claire’s |
9% |
|
$10 |
|
|
$ |
|
Cold Stone Creamery |
8% |
|
$10 |
|
|
$ |
|
Crate & Barrel |
8% |
|
$25 |
|
$100 |
$ |
|
CVS (Longs Drugs) |
6% |
|
$25 |
|
$100 |
$ |
|
Disney |
2% |
|
$25 |
|
$100/$1000 |
$ |
|
Gamestop |
3% |
|
$25 |
|
|
$ |
|
Gap/Old Navy/etc. |
9% |
|
$25 |
|
|
$ |
|
Gift Card Envelopes (16) |
20% |
|
$5.60 |
|
|
$ |
|
Golfsmith |
8% |
|
$25 |
|
|
$ |
|
Gymboree |
13% |
|
$25 |
|
|
$ |
|
Home Depot/Expo |
4% |
|
$25 |
|
$100 |
$ |
|
iTunes |
5% |
|
$15 |
|
$25 |
$ |
|
J. Crew |
13% |
|
$25 |
|
|
$ |
|
Jamba Juice |
7% |
|
$10 |
|
|
$ |
|
Jo-Ann Fabrics |
6% |
|
$20 |
|
|
$ |
|
KFC |
8% |
|
$5 |
|
|
$ |
|
Kohl’s Department Store |
4% |
|
$25 |
|
$100 |
$ |
|
Lowe’s |
4% |
|
$25 |
|
$100/$500 |
$ |
|
Lucky |
2% |
|
$25 |
|
$100 |
$ |
|
Page 1 Subtotal $ ____________ |
|
Merchants |
% |
Quantity |
Card Value |
Quantity |
Card Value |
Total |
|
Macys |
10% |
|
$25 |
|
$100 |
$ |
|
Marie Calendars |
18% |
|
$25 |
|
|
$ |
|
Marshalls/TJ Maxx |
7% |
|
$25 |
|
$100 |
$ |
|
Men’s Wearhouse |
8% |
|
$25 |
|
|
$ |
|
Michaels |
4% |
|
$25 |
|
|
$ |
|
Mimi’s Café |
8% |
|
$25 |
|
|
$ |
|
Olive Garden |
9% |
|
$25 |
|
|
$ |
|
Omaha Steaks |
11% |
|
$25 |
|
|
$ |
|
Outback Steakhouse |
8% |
|
$25 |
|
|
$ |
|
Peet’s Coffee & Tea |
8% |
|
$20 |
|
|
$ |
|
PF Chang’s |
8% |
|
$25 |
|
|
$ |
|
Pottery Barn/Williams Sonoma |
8% |
|
$25 |
|
$100 |
$ |
|
Regal Ent (UA Theaters) |
8% |
|
$25 |
|
|
$ |
|
Restoration Hardware |
12% |
|
$25 |
|
$100 |
$ |
|
Ruth’s Chris Steak House |
10% |
|
$50 |
|
|
$ |
|
Safeway |
4% |
|
$25 |
|
$100 |
$ |
|
Sears/Orchard Supply |
4% |
|
$25 |
|
$100/$250 |
$ |
|
See’s Candies 1lb |
23% |
|
$15.60 |
|
|
$ |
|
Shell |
2.5% |
|
$50 |
|
|
$ |
|
Shutterfly |
9% |
|
$25 |
|
|
$ |
|
Staples |
5% |
|
$25 |
|
$100 |
$ |
|
Starbucks |
7% |
|
$10 |
|
$25 |
$ |
|
The 202 Grill (locally owned!) |
5% |
|
$25 |
|
|
$ |
|
The Children’s Place |
12% |
|
$25 |
|
|
$ |
|
The Container Store |
9% |
|
$25 |
|
$100 |
$ |
|
Toys R Us/Babies R Us |
1.5% |
|
$20 |
|
|
$ |
|
Walgreens |
7% |
|
$25 |
|
$100 |
$ |
|
Wal Mart/Sam’s Club |
2% |
|
$25 |
|
$100 |
$ |
|
NEW!! Whole Foods |
4% |
|
$100 |
|
|
$ |
|
Yogurt Shack |
12% |
|
$25 |
|
|
$ |
|
Write additional retailers in . . .. . |
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$ |
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$ |
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$ |
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$ |
Visit www.glscrip.com for entire retailer list
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Page 2 Subtotal $ ____________ |
|
Office Use Only Coordinator Initials: _____________
Date received: ____________ Check Amount:_________
Date delivered: ___________ Check#: ______________
|
Page 1 subtotal _____________ Page 2 subtotal _____________
TOTAL _____________ |
|
Please read and sign below: I understand that all SCRIP cards will be delivered to my child’s classroom (noted above) and that the student will put the cards in their backpack in a sealed envelope. See Eagle website for order/delivery date schedule.
Signed:________________________________________ Date__________________________ We accept CHECKS ONLY. Please make checks payable to Greenbrook Eagle Fund. All sales are final. |
Questions, contact: Tara Parsons 837-4038 taraparsons@sbcglobal.net, or Karen Atkins 855-0962 kjl_atkins@sbcglobal.net
8/7/09 Rev14