| Brownsburg Swim Club Scrip Program Order Form (Listed Rates as
of April 15, 2008) |
| This is only a
hot-list of vendors. See Heather
Scaife or www.glscrip.com for a complete list of retailers. |
| Family Name
________________ Phone
__________ Date ______ Check #______ |
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Normal |
Cirtificate Values Available |
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| Vendor type |
Vendor |
% |
Value |
Qty |
Value |
Qty |
Value |
Qty |
Order Value |
| Groceries |
GFS |
4.0% |
$25 |
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$100 |
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Kroger |
5.0% |
$10 |
|
$25 |
|
$50 |
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Marsh/O'Malia's |
5.0% |
$10 |
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$25 |
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$50 |
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Wal-Mart |
2.0% |
$25 |
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$100 |
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$250 |
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| Gas
Stations |
BP |
2.0% |
$50 |
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Marathon |
3.0% |
$25 |
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$100 |
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$250/4% |
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Mobil/Exxon |
1.5% |
$50 |
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Shell |
1.5% |
$25 |
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$100 |
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Speedway |
4.0% |
$25 |
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$100 |
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| Restaurants |
Applebees |
8.0% |
$25 |
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Arby's |
8.0% |
$10 |
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Bob Evans |
10.0% |
$10 |
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Burger King |
4.0% |
$10 |
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Cheeseburgs in
Paradise |
5.0% |
$25 |
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Chili's |
11.0% |
$25 |
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Chuck E. Cheese |
8.0% |
$10 |
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Cracker Barrel |
9.0% |
$10 |
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Domino's Pizza |
5.0% |
$5 |
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Donatos |
10.0% |
$10 |
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Fazoli's |
7.0% |
$25 |
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KFC |
9.0% |
$5 |
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Max & Erma's |
13.0% |
$20 |
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O'Charley's |
13.0% |
$25 |
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Old Country
Buffet |
5.0% |
$25 |
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Olive Garden |
9.0% |
$25 |
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On the Border |
11.0% |
$25 |
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Outback
Steakhouse |
5.0% |
$25 |
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Panera Bread |
9.0% |
$10 |
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Papa Johns |
8.0% |
$10 |
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Pizza Hut |
8.0% |
$10 |
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Red Lobster |
9.0% |
$25 |
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Starbucks |
7.0% |
$10 |
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$25 |
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Subway |
3.0% |
$10 |
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$50 |
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Texas Roadhouse |
8.0% |
$25 |
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Wendy's |
4.0% |
$10 |
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| Subtotal |
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| Vendor type |
Vendor |
% |
Value |
Qty |
Value |
Qty |
Value |
Qty |
Order Value |
| Retail/Service |
Amazon.com |
4.0% |
$25 |
|
$100 |
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American Eagle
Outfitters |
8.0% |
$25 |
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Barnes &
Noble |
9.0% |
$10 |
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$25 |
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$100 |
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Bath & Body
Works |
13.0% |
$10 |
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$25 |
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Bed Bath &
Beyond |
7.0% |
$25 |
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Best Buy |
2.0% |
$25 |
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$100 |
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$250 |
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Build-A-Bear
Workshop |
8.0% |
$25 |
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Claire's |
9.0% |
$10 |
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CVS Pharmacy |
6.0% |
$25 |
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Disney |
2.0% |
$25 |
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$100 |
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$1,000 |
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Dress Barn |
8.0% |
$25 |
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Gap/Old Navy |
9.0% |
$25 |
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Great Clips |
8.0% |
$25 |
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iTunes |
4.0% |
$15 |
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JC Penney |
5.0% |
$25 |
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$100 |
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Jo Ann Fabrics |
6.0% |
$20 |
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K mart |
4.0% |
$25 |
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$50 |
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Kohl's (Holiday
Season Only) |
4.0% |
$25 |
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$100 |
Team Order of $500 |
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Lowes |
4.0% |
$25 |
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$100 |
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$500 |
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Menards |
3.0% |
$25 |
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$100 |
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Old Navy/Gap |
9.0% |
$25 |
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Payless Shoes |
13.0% |
$20 |
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Pier 1 Imports |
9.0% |
$25 |
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Sears |
4.0% |
$25 |
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$100 |
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$250 |
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Shoe Carnival |
5.0% |
$25 |
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Staples |
5.0% |
$25 |
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$100 |
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Waldenbooks |
9.0% |
$10 |
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$25 |
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Walgreens |
2.0% |
$20 |
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$100 |
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| Entertainment |
Blockbuster
Giftcard |
7.0% |
$10 |
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Blockbuster
Movie |
15.0% |
$3.79 |
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Blockbuster Game |
15.0% |
$6 |
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Regal/United
Artists |
8.0% |
$25 |
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Regal Single
Movice |
16.0% |
$9 |
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| Travel |
American
Airlines |
8.0% |
$100 |
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$250 |
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Avis or Budget
(Circle One) |
8.0% |
$50 |
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Best Western |
12.0% |
$25 |
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$100 |
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Carnival
Cruises, Tkt Purch Only |
8.0% |
$100 |
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Comfort/Quality/Sleep Inns |
6.0% |
$25 |
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$100 |
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Disney |
2.0% |
$25 |
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$100 |
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$1,000 |
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Hyatt Hotels |
9.0% |
$25 |
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$100 |
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Marriott/Fairfield
Hotels |
12.0% |
$50 |
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$100 |
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$500 |
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Ritz-Carlton
Hotels |
12.0% |
$50 |
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| Others |
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| Total
From This Side |
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| Total
From Other Side |
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| Grand
Total |
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