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