SCRIP ON HAND WHILE SUPPLIES LAST Applebees ($25) ______ Best by trendy3

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									ARCADIA CHRISTIAN SCHOOL SCRIP ORDER FORM
Parent Name ___________________________________ Student Name __________________________________ Phone Number _________________________________ EFFECTIVE JANUARY 1, 2008 PLEASE HAVE ORDERS TURNED IN TO THE OFICE THURSDAYS BEFORE 10:00 A.M. TO ENSURE DELIVERY THE FOLLOWING THURSDAY. SCRIP WILL NO LONGER BE KEPT “ON HAND” Date ____________________________________ Teacher __________________________________

SCRIP “ON HAND” WHILE SUPPLIES LAST
Acapulco ($25) _____________

Applebees ($25) ___________ Best Buy ($25) ____________ Black Angus ($10) _________ Chevy’s ($10) ____________ Chipolte ($10) ____________ Claire’s ($10) _____________ Coco’s ($10) ______________ Dave & Buster ($25) _______ Denny’s ($5) _____________

Disney ($25) _____________ Domino’s ($25) ___________ Hometown Buffet (25) ______ Honey Bkd. Ham ($10) _____ Islands ($25) ______________ JC Penney ($25) ___________ KFC ($5) ________________ Linen & Thing ($25) _______ Marie Callendar ($25) ______ Mobil ($50) ______________

Office Depot ($25) _________ Old Navy ($25) ____________ Olive Garden ($25) _________ Outback ($25) _____________ Pizza Hut ($10) ____________ Red Robin ($10) ___________ Sally Beauty ($25) _________ Sears ($25) _______________ Stater Bros ($25) ___________ 99 Ranch ($20) ____________

PLEASE LIST THE RETAILER AND DOLLAR AMOUNT OF SCRIP NEEDED YOU CAN SEE ALL AVAILABLE RETAILERS AT THE GREAT LAKES SCRIP WEBSITE: www.glscrip.com RETAILER/DENOMINATION ARCO ($50)_______________________________________ ALBERTSONS ($25)_($100) Please circle_______________ CHEVRON_($50)_($100)_Please circle_________________ VONS ($25)_($100) Please circle______________________ STARBUCKS ($10 OR $25) Please circle______________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ DOLLAR AMOUNT __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

_____ _____ _____ _____

Send scrip to office. I will pick up there. Send scrip to daycare. I will pick up there. Send scrip to preschool. I will pick up there. I want my child to receive my scrip. (SIGNATURE REQUIRED)

Signature __________________________ Date ____________
Authorizing ACS to release this order to my child as requested above, and also releasing ACS of liability for any lost Scrip.

OFFICE USE Check Number _______ Check Amount _______ Cash _______ Total _______ Initials _______ Date _______ Revised: 2/2008

For additional assistance regarding SCRIP please call: Joanne Scigliano (626) 287-0998 or Linda Gorman at ACS (626) 574-8229


								
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