Scrip Order Form

Lammersville School Foundation

Purchase the same gift cards you do at the store and support your school.
Lammersville receives the % listed based on the gift card value at no extra cost to you!
We accept cash, check (payable to LSF) or credit card.
Name:

Credit Card # (Minimum $100 purchase):

Product
Ace Hardware $100.00
Ace Hardware $25.00
Aeropostale $25.00
Amazon.com $25.00
Amazon.com $100.00
AMC Theatres $25.00
AMC Theatres Gold Ticket $9.50
American Airlines $100.00
American Airlines $250.00
American Eagle Outfitters $25.00
Applebee's $25.00
Applebee's $50.00
Arby's $10.00
AT&T 125 Minute Prepaid Card $9.50
AutoZone $25.00
Avis Car Rental $50.00
Baja Fresh $25.00
Barnes & Noble Booksellers $10.00
Barnes & Noble Booksellers $20.00
Barnes & Noble Booksellers $25.00
Barnes & Noble Booksellers $100.00
Baskin Robbins $2.00
Bass Pro Shops $25.00
Bass Pro Shops $100.00
Bath & Body Works $10.00
Bath & Body Works $25.00
Bed Bath & Beyond $25.00
Bed Bath & Beyond $100.00
Best Buy $25.00
Best Buy $100.00
Best Buy $250.00
Best Western International $25.00
Best Western International $100.00
Big 5 Sporting Goods $25.00
Black Angus $25.00
Boston Market $10.00
Bubba Gump Shrimp Co. $25.00
Bubba Gump Shrimp Co. $100.00
Buca di Beppo $25.00
Budget Car Rental $50.00
Build-A-Bear Workshop $25.00
Burger King $10.00
Burlington Coat Factory $25.00
California Pizza Kitchen $10.00
Carl's Jr. $10.00
Carnival Cruise Lines $100.00
Casual Male XL $25.00
Cheesecake Factory $25.00
Children's Place $25.00
Chili's Grill & Bar $25.00
Chipotle Mexican Grill $10.00
Chuck E. Cheese $10.00
Cinemark Theatres Single Admit $9.50
Cinemark Theatres $25.00
Claire's $10.00
Cold Stone Creamery $10.00
Comfort Inn $50.00

Contact Info (Email or Phone):

Expiration Date: Check #:

%
QTY
Total
4.00%
$
4.00%
$
7.00%
$
4.00%
$
4.00%
$
**12.00%
$
16.00%
$
8.00%
$
8.00%
$
10.00%
$
8.00%
$
8.00%
$
8.00%
$
20.00%
$
8.00%
$
8.00%
$
7.00%
$
9.00%
$
9.00%
$
9.00%
$
9.00%
$
9.00%
$
9.00%
$
9.00%
$
13.00%
$
13.00%
$
7.00%
$
7.00%
$
3.00%
$
3.00%
$
3.00%
$
12.00%
$
12.00%
$
8.00%
$
12.00%
$
12.00%
$
9.00%
$
9.00%
$
8.00%
$
8.00%
$
8.00%
$
4.00%
$
8.00%
$
4.00%
$
5.00%
$
8.00%
$
9.00%
$
5.00%
$
12.00%
$
11.00%
$
10.00%
$
8.00%
$
15.00%
$
4.00%
$
9.00%
$
8.00%
$
4.00%
$

Pick up in office

Send home with student*
* LSF will not be held liable for lost or misplaced cards

Product
Comfort Inn $100.00
Comfort Suites $50.00
Comfort Suites $100.00
Courtyard by Marriott $50.00
Courtyard by Marriott $100.00
Courtyard by Marriott $500.00
Crate and Barrel $25.00
Crate and Barrel $100.00
Crazy 8 $25.00
CVS/pharmacy $25.00
CVS/pharmacy $100.00
Darden Restaurants $25.00
Dave & Buster's $25.00
Del Taco $10.00
Denny's $10.00
Dillard's $100.00
Dillard's $25.00
Disney $25.00
Disney $100.00
Disney $1000.00
Domino's Pizza $10.00
Econo Lodge $50.00
Econo Lodge $100.00
Express $25.00
Express for Men $25.00
Fairfield Inn & Suites by Marriott $50.00
Fairfield Inn & Suites by Marriott $100.00
Fairfield Inn & Suites by Marriott $500.00
Fairmont Hotels $100.00
Fashion Bug $25.00
Finish Line $25.00
Food Maxx $25.00
Food Maxx $100.00
Foot Locker $25.00
GameStop $25.00
Gap $25.00
GNC $25.00
Groupon.com $25.00
Hallmark $25.00
Hard Rock Cafe $25.00
Home Depot $25.00
Home Depot $100.00
Home Depot $500.00
Home Depot $1000.00
HomeGoods $25.00
HomeGoods $100.00
Hometown Buffet $25.00
Honey Baked Ham $10.00
Hyatt Hotels $50.00
Hyatt Hotels $100.00
Hyatt Summerfield Suites $50.00
Hyatt Summerfield Suites $100.00
Icing $10.00
IHOP $25.00
iTunes $15.00
iTunes $25.00
J. Crew $25.00

Order Date:

Date Needed:

%
QTY
4.00%
$
4.00%
$
4.00%
$
8.00%
$
8.00%
$
8.00%
$
8.00%
$
8.00%
$
13.00%
$
6.00%
$
6.00%
$
9.00%
$
13.00%
$
4.00%
$
7.00%
$
9.00%
$
9.00%
$
2.00%
$
2.00%
$
2.00%
$
8.00%
$
4.00%
$
4.00%
$
10.00%
$
10.00%
$
8.00%
$
8.00%
$
8.00%
$
12.00%
$
6.00%
$
10.00%
$
2.00%
$
2.00%
$
9.00%
$
3.00%
$
14.00%
$
8.00%
$
7.00%
$
4.00%
$
10.00%
$
4.00%
$
4.00%
$
4.00%
$
4.00%
$
7.00%
$
7.00%
$
5.00%
$
12.00%
$
9.00%
$
9.00%
$
9.00%
$
9.00%
$
9.00%
$
8.00%
$
5.00%
$
5.00%
$
13.00%
$

Total

Created: 10/13/2011 5:35:02 PM

**Limited time bonus offer. Participating retailers and products are subject to change without notice.

Product
J. Jill $25.00
Jack in the Box $10.00
Jamba Juice $10.00
JCPenney $25.00
JCPenney $100.00
Journeys $25.00
Journeys Kidz $25.00
KFC $5.00
Kids Foot Locker $25.00
Kmart $25.00
Kmart $50.00
Kohl's $25.00
Kohl's $100.00
Lane Bryant $25.00
Limited $25.00
Little Caesar's Pizza $20.00
Lowe's $20.00
Lowe's $25.00
Lowe's $100.00
Lowe's $500.00
Lowe's $1000.00
Macaroni Grill $25.00
Macy's $25.00
Macy's $100.00
Maggiano's Little Italy $25.00
Marriott Hotels & Resorts $50.00
Marriott Hotels & Resorts $100.00
Marriott Hotels & Resorts $500.00
Marshalls $25.00
Marshalls $100.00
Maurices $20.00
Men's Wearhouse $25.00
Michaels $25.00
Mimis Cafe $25.00
Motherhood Maternity $25.00
Old Navy $25.00
Olive Garden $25.00
On The Border $25.00
Outback Steakhouse $25.00
Overstock.com $25.00
P.F. Chang's China Bistro $25.00
Panera Bread $10.00
Panera Bread $25.00
Papa Murphy's Pizza $10.00
Payless Shoes $20.00
PBteen $25.00
PBteen $100.00
Peet's Coffee & Tea $20.00
PetSmart $25.00
Pizza Hut (Not AK or HI) $10.00
Pottery Barn $25.00
Pottery Barn $100.00
Pottery Barn Kids $25.00
Pottery Barn Kids $100.00
Qdoba Mexican Grill $25.00
Quality Inn $50.00
Quality Inn $100.00
Radio Shack $25.00

%
QTY
Total
8.00%
$
4.00%
$
7.00%
$
5.00%
$
5.00%
$
10.00%
$
10.00%
$
8.00%
$
9.00%
$
4.00%
$
4.00%
$
4.00%
$
4.00%
$
6.00%
$
9.00%
$
8.00%
$
4.00%
$
4.00%
$
4.00%
$
4.00%
$
4.00%
$
11.00%
$
10.00%
$
10.00%
$
11.00%
$
8.00%
$
8.00%
$
8.00%
$
7.00%
$
7.00%
$
7.00%
$
8.00%
$
4.00%
$
8.00%
$
8.00%
$
14.00%
$
9.00%
$
11.00%
$
8.00%
$
8.00%
$
8.00%
$
**10.00%
$
**10.00%
$
8.00%
$
13.00%
$
8.00%
$
8.00%
$
8.00%
$
4.00%
$
8.00%
$
8.00%
$
8.00%
$
8.00%
$
8.00%
$
7.00%
$
4.00%
$
4.00%
$
4.00%
$

Product
%
QTY
9.00%
$
Red Lobster $25.00
9.00%
$
Red Robin $25.00
8.00%
$
REI $25.00
8.00%
$
Residence Inn by Marriott $50.00
Residence Inn by Marriott $500.00
8.00%
$
Restaurant.com $20.00
50.00%
$
Restoration Hardware $25.00
12.00%
$
Restoration Hardware $100.00
12.00%
$
Rite Aid $25.00
4.00%
$
Rocky Mountain Chocolate Factory $10.00
11.00%
$
Ross Dress for Less $25.00
8.00%
$
10.00%
$
Ruth's Chris Steak House $50.00
4.00%
$
Safeway $25.00
4.00%
$
Safeway $100.00
2.00%
$
Save Mart Supermarkets $25.00
2.00%
$
Save Mart Supermarkets $100.00
Sears $25.00
4.00%
$
Sears $100.00
4.00%
$
Sears $250.00
4.00%
$
Sears Auto Service Center $25.00
4.00%
$
Sears Auto Service Center $250.00
4.00%
$
Sears Auto Service Center $100.00
4.00%
$
See's Candies $16.50
20.00%
$
Sephora $20.00
4.00%
$
Shell $25.00
2.50%
$
Shell $50.00
2.50%
$
Shell $100.00
2.50%
$
Shutterfly $25.00
9.00%
$
Six Flags One-Day Admission Ticket $32.00
8.00%
$
Smart & Final $25.00
3.00%
$
Smart & Final $50.00
3.00%
$
Smart & Final $100.00
3.00%
$
Staples $25.00
5.00%
$
Staples $100.00
5.00%
$
Starbucks $10.00
7.00%
$
Starbucks $25.00
7.00%
$
Subway $10.00
3.00%
$
Subway $50.00
3.00%
$
Sunglass Hut $25.00
12.00%
$
Supercuts $25.00
8.00%
$
Sweet Tomatoes $25.00
8.00%
$
T.J. Maxx $25.00
7.00%
$
T.J. Maxx $100.00
7.00%
$
Target $25.00
2.00%
$
Target $100.00
2.00%
$
Texas Roadhouse $25.00
8.00%
$
TGI Friday's $25.00
9.00%
$
ULTA $25.00
4.00%
$
Walgreens $100.00
6.00%
$
Walgreens $25.00
6.00%
$
Walmart $25.00
2.00%
$
Walmart $100.00
2.00%
$
Walmart $250.00
2.00%
$
Wendy's $10.00
4.00%
$
Williams-Sonoma $25.00
8.00%
$
Williams-Sonoma $100.00
8.00%
$
Zappos.com $25.00
8.00%
$
$
Grand Total (all columns)

Total

Your Scrip Coordinator is

Nancy Treolo
vicepresident@lammersvilleschoolfoundation.org

PLEASE REVIEW YOUR ORDER CAREFULLY

NO REFUNDS OR EXCHANGES

Created: 10/13/2011 5:35:02 PM

**Limited time bonus offer. Participating retailers and products are subject to change without notice.