Name:______Personal Gift Card Order Form Scrip Phone:______Service Center - November 2018 Email:______$ $ Total $ GROCERY QTY Total AUTOMOTIVE # RESTAURANTS Cont. # Total $10 Eco Car Wash 1 wash Save $1 26% $6 Oswego Grill & Copper River 8% $25 $20 Jiffy Lube * 15% $30 8% $25 Fred Meyer /QFC/Kroger 4% $25 Kaady Car Wash 1 wash Save $1 22% $7 8% $15 $50 Washman Car Wash* 1 wash Save $1 26% $6 & Cafe 8% $10 $100 RESTAURANTS Papa John’s Pizza* OR & SW WA 10% $5 Natural Grocers 4% $50 Applebee’s 8% $10 Papa Murphy’s Pizza 8% $10 $50 8% $10 Pastini Pastaria 8% $25 New Seasons 4% $100 Bellagios Pizza 5% $20 Pizza Caboose* 8% $10 $25 Big Town Hero* 8% $5 Pizzicato Gourmet Pizza * Safeway/Albertsons 4% $50 Buffalo Wild Wings 8% $25 Not airport, Bend, or Hood River 8% $10 $100 4% $5 No change back. Bales/Lambs Thriftway 4% $50 Burgerville 10% $10 Portland City Grill See Stanfords to order $50 5% $10 ® Carl’s Jr. / Green Burrito Whole Foods Market 3% $100 Chevy’s 8% $15 7% $10 RETAIL / DEPARTMENT Chipotle 9% $10 Roundtable Pizza- any location 12% $10 Adidas 13% $25 Claim Jumper See Landry's to order Shari’s Restaurant 8% $20 Bed, Bath, & Beyond 5% $10 Copper River Restaurant & Bar Hillsboro See Oswego Grill to order Sonic Drive-In 8% $10 Bridgeport Village All stores, Cracker Barrel 8% $25 Stanford's/Manzana's/Henry's 4% $25 kiosks, restaurants & theater. Davidson’s* - Tigard - No change 8% $10 Taveran,Portland City Grill, Newport 8% $25 Cabela's 8% $25 Denny’s Restaurant 5% $10 Seafood Grill, and more Domino’s Pizza * OR and WA only 12% $10 can be used to pay for school lunch $15 Columbia Sportswear Retail 12% $50 - 6% outlets,employee stores for those w/ access.. Elmer’s Pancake House* 8% $5 programs $100 Dicks Sporting Goods 8% $25 Famous Daves BBQ 10% $25 Sweet Tomatoes 8% $25 DSW - Shoes 8% $25 Godfather’s Pizza* Med Special or Lrg 2 top 28% $16 4% $10 GAP See Old Navy to order HoneyBaked Ham 13% $10 Taco Time OR and SW Wash. 15% $15 Home Goods See Marshalls to order Izzy’s Pizza 8% $20 Tom’s Pancake House* No Change back 8% $10 JC Penney 4% $25 See Happy Teen card Veggie Grill 9% $15 - multi use card Kohl’s Also payment on acct. in store. 4% $25 to order -4th row Yard House Order @ Olive Garden Macy’s 10% $25 John’s Incredible Pizza Co 8% $25 Marshall’s-TJ Maxx/ HomeGoods 6% $25 Landry’s Restaurants - ENTERTAINMENT/TRAVEL/VISA Claim Jumper, Morton’s Steak, Harborside Nike, Inc. Nike Town, Online, Outlets, 9% $25 Cinemark* - Century Theaters 7% $9.00 12% $50 Jake’s Grill &Crawfish,Bubba Gump McCormick & Employee store for those with access Schmick’s,Chart House, Family Fun Center & Bullwinkle's 15% $25 Nordstrom 4% $25 McCormick and Schmick's See Landry's to order Games,cars,golf, and food Wilsonville Only McGrath’s Fish House 7% $10 Family Theaters* Tigard and Oak Grove 16% $10 Old Navy Gap Banana Republic 12% $25 GAP KIDS ~ Outlet Stores One Card for All McMenamins / Ruby’s Spa Regal Cinemas Gift Card 7% $15 Payless Shoe Source 12% $25 For any Restaurant, Brew Pub,Spa, 12% $25 Good all hours and for concessions Hotel,Theater, Gift Shop, Hair Salon R.E.I. All Stores and Online 8% $25 Regal Cinemas * Paper Ticket 7% $10 Ross Dress for Less 8% $25 Noodles & Company 8% $10 Adult prime time ticket is less than door price Sears- Kmart-Lands End 5% $50 Old Spaghetti Factory-New Denom 8% $25 Visa® Prepaid Card - No ACTIVATION Fee 1.5% $50 Target 2.5% $25 Olive Garden/Yard House 8% $10 check "valid thru" date on card The Children’s Place 12% $25 If used at Winco they require a pin # Victoria's Secret 5% $25 1Card Issued by MetaBank®, Member FDIC. Terms, conditions, expiry apply - see program website for details. Walgreens 4% $25 www.ttsdschools.org/scripservicecenter Walmart 1% $25 * Paper Certificate - no change back No card return. 11-1-18 Group: Date:______

SPECIALTY STORES # $ Total ACE Hardware 4% $25 $25 For online. Can load Amazon.com 3% funds on account for future purchases. $100

Backyard Bird Shop 8% $25 Barnes & Noble 8% $10 Bath & Body Works 7% $10 Best Buy 2% $50 Big 5 Sporting Goods 8% $25 Build A Bear Workshop 8% $25 Coastal Farm & Ranch 4% $25 15% $5 Craft Warehouse 8% $10 Happy Teen-multi use card 5% $25 Home Depot 3% $50 iTunes Internet music & more 3% $25 Joann Fabrics 5% $25

Krispy Kreme*1 dz glazed/3 max visit 41% $10 Lowe’s 4% $50 Michaels Crafts 3% $25 Office Depot 7% $25 Peet's Coffee 8% $20 Petco 8% $25 Petsmart 4% $25 Pier 1 Imports 8% $25 Pottery Barn -Williams Sonoma 7% $25 Powell’s Books 8% $10 Sally Beauty 8% $25 See’s Candy* 1 lb. certificate $20.50 per lb.in store-save $1.50 per lb 10% $19

Sephora 4% $25 Staples Office Supplies 4% $25 $5 Coffee 6% $10 $25 Ulta 3% $25 Chinook App-Adroid or iPhone 50% $15 Chinook Book + App 50% $25

Total all columns = $ ______Please make check payable to: ______Thank You for your Support!