Ruby's Diner Scrip Program Order Form by brokeNCYDE

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									                             Ruby’s Diner Scrip Program
                             Order Form
Name

Organization

Address

Phone                                                         Contact Phone:

               Gift Card            Gift Card                      # of Cards
               Amount               Quantity          Total          Earned             Total
Example:          $25*                 20         $500                  2           $550
                  $25                             $                                 $
                  $25                             $                                 $
                  $25                             $                                 $
                  $25                             $                                 $
                                      Shipping $6.00
                         Total Check Amount

Shipping
All orders will be shipped UPS unless otherwise specified. All deliveries will require a signature to ensure
you order has been received.

Or, you may bill to your account:        Fed X           UPS           Airborne
                                         Ground          2nd Day       Overnight

Billing #


                       Please mail your check and order form to the address below.
                      Allow 5-10 Business days after your order has been confirmed.


Would you like to be sent additional information regarding Ruby’s “Fundraiser Night Program” and/or
Ruby’s Student Award Program”?         YES             NO



                                        Ruby’s Marketing Department
                                                  557 Wald
                                              Irvine, CA 92618
                                           (949) 644-7829, ext.140

								
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