CALVARY CHAPEL OF Chili’s 11% __25 __50 Chipotle 10% __10 COSTA MESA Chuck E. Cheese 8% __10 SCRIP ORDER FORM Circle K 1.5% __25 __100 Scrip office is in the MCA Lunchroom (room 6) Claim Jumper 9% __25 __100 Hours: M-F 7:30am-4pm Claire’s 9% __10 STEP 1: FILL IN CONTACT INFORMATION Clarion 3% __50 __100 Date Coco’s Bakery 8% __10 Name Coffee Bean 9% __25 Cell phone: Cold Stone 8% __10 Comfort Inn 3% __50 __100 STEP 2: CHOOSE FROM THE FOLLOWING MERCHANTS Container Store 9% __25 __100 QUESTIONS? CALL SUNDAY GARCIA at (714) 290-7786 Crate & Barrel 8% __25 __100 Fax orders (714) 424-9602, e-mail orders [email protected] Crazy Horse Steak House 5% __25 STEP 3: CALCULATE DOLLAR VALUE OF YOUR ORDER. CVS Pharmacy 6% __25 __100 Check # Dave & Busters 13% __25 Make checks payable to CALVARY CHAPEL COSTA MESA Del Taco 4% __10 TOTAL ORDER : $______Dell 4% __100 Thank you for your ongoing support! (revised 11/9/14) Denny’s 7% __10 STEP 4: COMPLETE RELEASE FORM BELOW Dick’s Sporting Goods 8% __25 __100 By signing below, I authorize Calvary Chapel Scrip to release Scrip to: Disney gift card 2% __15__25 __100 ______(name of student) for delivery to me. The __1000 appearance of my signature below also holds this school harmless from Domino’s Pizza 8% __10 loss once Scrip is delivered. Dunkin Donuts 3% __10 __25 Signature of Parent/Guardian ______E B Games 3% __25 Profit = % amount merchant donates to Calvary Chapel Scrip Edwards Theater 8% __25 MERCHANTS Profit $Value ( __Qty) TOTAL
Edwards singles 10% __9.50 76 Gas 1.5% __25 __100 El Pollo Loco 6% __10 Acapulco 8% __25 El Torito 8% __25 Ace Hardware 4% __25 __100 Essential Oils 10% __25 __50 __100 Albertson’s 4% __25 __100 Express 10% __25 Amazon.com 3% __25 __100 Exxon 1% __50 __250 AMC Theaters 8% __25 Fairmont Hotel & Resorts 9% __100 AMC Single Admission 10% __9.50 Family Christian Stores 9% __25 American Eagle 10% __25 Family Video 12% __10 American Express 1.25% __25 __100 __200 Finish Line 10% __25 Flame Broiler (FV Brookhurst) Applebee’s 8% __25 __50 8% __25 Arby’s 8% __10 Foot Locker Stores 9% __25 Arco gasoline 1.5% __50 __100 FV Skate Center 5% __20 Arco gasoline 2.5% __250 Game Stop 3% __25 AT&T 125+ min 20% __9.50 Gap 14% __25 __100 Auto Zone 8% __25 GNC 8% __25 Avis car rental 8% __50 Golfsmith 8% __25 Babies-R-Us 3% __20 Groupon.com 7% __25 Baby Gap 14% __25 Guitar Center 4% __25 Baja Fresh 7% __25 Gymboree (clothing only) 13% __25 Banana Republic 14% __25 __100 Hallmark 4% __25 Barnes & Noble 9% __10 __25 __100 Hard Rock Cafe 10% __25 Bass Pro Shops 9% __25 __100 Home Depot 4% __25 __100 __500 __1000 Bath & Body Works 13% __10 __25 Home Goods 7% __25 __100 Bed Bath & Beyond 7% __25 __100 Honey Baked Ham 12% __25 Best Buy 3% __25 __100 __250 Hyatt Hotels 9% __50 __100 Best Western 12% __25 __100 IHOP 8% __25 Big 5 Sporting Goods 8% __25 In-N-Out 2% __5 __10 __25 12% __25 Black Angus iTunes 5% __15 __25 Bloomingdale’s 12% __25 __100 Islands 8% __25 Body Shop, the 8% __25 Jack-in-the-Box 4% __10 Boston Market 12% __10 Jamba Juice 7% __10 Breugger’s Bagels 7% __10 JC Penny 5% __25 __100 Buca di Beppo 8% __25 Jiffy Lube 8% __30 Budget car rental 8% __50 Jo Ann Fabrics 6% __25 Build-A-Bear 8% __25 K Mart 4% __25 __50 Burger King 4% __10 KFC 8% __5 Burlington Coat 8% __25 Kid’s Foot Locker 9% __25 CA Pizza Kitchen 8% __10 Kohl’s 4% __25 __100 Cambria Suites 3% __50 __100 Land’s End 16% __25 __100 Carrow’s 8% __10 Lamppost Pizza 10% __10 __25 Century 4% __25 Limited 9% __25 Century Singles 10% __9.50 Little Caesar’s 8% __20 Chart House 9% __25 __100 L L Bean 16% __25 __100 Cheesecake Factory 5% __25 Lowe’s Home Improvement 4% __20 __25 __100 Chevron 1% __50 __100 __250 __500 __1000 Chevy’s 8% __25 Macaroni Grill 11% __25 __50 Chick-fil-A 2% __10 Macy’s 10% __25 __100 Sports Authority 8% __25 __100 Maggiano’s 11% __25 __50 Sprouts 5% __25 __50 __100 MainStay Suites 3% __50 __100 Staples 5% __25 __100 Marshall’s 7% __25 __100 Starbucks 7% __5 __10 __25 McDonalds 1.25% __5 __10 Stater Brothers 6% __5 __10 __25 __50 Men’s Wearhouse 8% __25 __100 __250 Michael's 4% __25 Subway 3% __10 __50 Mimi’s 8% __25 Sunglass Hut 12% __25 Mobil 1% __50 __250 Supercuts 8% __25 Morton's Steakhouse 9% __25 __100 T J Max 7% __25 __100 Motherhood Maternity 8% __25 Taco Bell 5% __10 Mother’s Market 5% __25 _100 Talbot’s 13% __25 Neiman Marcus 12% __50 Target 2.5% __10__25__50__ !00 Nike 12% __25 Texas Roadhouse 8% __25 Nutrisystem 12% __50 TGI Fridays 9% __25 Office Depot 4% __25 __100 The Children’s Place 12% __25 Office Max 5% __25__100 Tony Roma's 12% __25 Old Navy 14% __25 __100 Toys-R-Us 3% __20 __100 Olive Garden 9% __25 Trader Joe’s 1.25% __25 __50 __100 On the Border 11% __25__50 United Artist Theater 8% __25 Oriental Trading 9% __25 Vons 4% __25 __100 Outback Steakhouse 8% __25 __50 Walgreens 6% __25 __100 Overstock.com 8% __25 Walmart 2.5% __25 __100 __250 Panda Express 8% __25 Wienerschnitzel 10% __10 Wendy’s 4% __10 Panera Bread 9% __10 __25 Whole Foods 3% __25 __100 Papa John’s 8% __10 Williams-Sonoma 8% __25 __100 8% __10 Papa Murphy's Wing Stop 10% __10 Pavillions 4% __25 __100 X-Box Live 6% __20 Payless Shoe Source 13% __20 Yard House 8% __25 Peet's Coffee and Tea 8% __20 Scrip may be purchased by cash, check, or credit card. Pep Boys 4% __20 Also available are colorful greeting cards for $2.00 & $4.00 each. PetSmart 4% __25 This is just a small sample of Scrip available to order. You can view a full P.F. Chang’s 8% __25 list at: www.glscrip.com Philly’s Best 10% __10 Credit card purchases of gift cards that contribute less than 3% may be Pier 1 Imports 9% __25 subject to a 3% service fee. Pizza Hut 8% __10 No portion of this purchase is tax deductible, if used for self. Pottery Barn Stores 8% __25 __100 Merchant list, dollar amounts, and rebate subject to change. Quality Inn 3% __50 __100 Some certificates are restricted to specific locations or proprietors. Radio Shack 4% __25 Returns or exchanges at our discretion. Rainforest Café 9% __25 __100 Red Lobster 9% __25 Red Robin 9% __25 Regal Entertainment 8% __25 Temporarily available: Regal Pack __28 Regal Singles 10% __9.50 Barnes and Noble $5 Regis Salons 8% __25 REI 8% __25 Pizza Hut $5 Renew Carpet Cleaning 10% __25 __50 __100 Panera $5 Restoration Hardware 12% __25 __100 Restaurant.com 50% __20 Rite Aid 4% __25 Walmart $10 Rocky Mt. Chocolate 11% __10 Amazon.com $10 Roman Cucina 5% __25 Ross Dress for Less 8% __25 Albertsons $10 Roy’s 8% __25 __50 AMC $10 Rubio's 2% __10 Ruby’s 5% __25 CVS $10 Ruth's Chris 10% __50 Groupon $10 Safeway 4% __25 __100 Ihop $10 Sally Beauty Co. 12% __25 Sams 2.5% __25 __100 __250 Outback $10 Sears 4% __25 __100 __250 Regal $10 Seasons 52 9% __25 See’s Candies 20% __ 18 See’s Candies 9% __25 Shell Gasoline 2.5% __25 __50 __100 Shutterfly 9% __25 Six Flags One-day Admission 8% __42.25 Skinsations Spa 10% __50 __100 Sleep Inn 3% __50 __100 Smart & Final 3% __25 __50 __100 Souplantation 8% __25 Spa Finder (wellness 365) 12% __25