8/27/2014 P.C.S. 2014-15 $CRIP-GIFT CARD Order Form

YOUR NAME

Daytime Phone **Benefit to PCS is indicated by the percentage next to each merchant

Student's Name/Classroom DEPARTMENT STORES Denom Qty Total RESTAURANTS (cont) Denom Qty Total Bloomingdale's (12%) 25 or 100 El Pollo Loco (6%) 10 JC Penney (5%) 25 or 100 Honeybaked Ham (12%) 25 Kohl's (4%) 25 or 100 IHOP (8%) 25 Macys (10%) 25 or 100 Islands (8%) 25 Sears (4%) 25 or 100 Jack-in-the-Box (4%) 10 Target (2.5%) 25 or 100 (7%) 10 Walmart (2.5%) 25 or 100 KFC (8%) 5 DRUG STORES Mimi's Café (8%) 25 CVS Pharmacy (6%) 25 Olive Garden/ (9%) 25 Rite Aid (4%) 25 (8%) 25 Walgreens (6%) 25 PF Changs/Pei Wei (8%) 25 ENTERTAINMENT (8%) 25 AMC/Loews/Cineplex (8%) 25 (9%) 10 or 25 AMC single ticket (10%) 9.50 Peet's Coffee and Tea (8%) 20 Disney (2%) 25 or 100 (5%) 10 Regal/Edwards/UA Theatres (8%) 25 (8%) 10 Regal/Edwards/UA single ticket (10%) 9.50 (9%) 25 Six Flags Magic Mtn. - 1-day admission 43 Ruth's Chris Steak House (10%) 50 GROCERIES Souplantation (8%) 25 Smart & Final (3%) 25 or 100 's (7%) 10 or 25 Sprouts Farmers Markets (5%) 25, 50 or 100 (3%) 10 Vons/Pavillions (4%) 25 or 100 (5%) 10 Whole Foods (3%) 25 or 100 Wendy's (4%) 10 HARDWARE & HOME SPECIALTY STORES Home Depot (4%) 25 or 100 Aeropostale (7%) 25 Lowe's (4%) 25 or 100 Amazon.com (3%) 25 or 100 RESTAURANTS American Eagle Outfitters (10%) 25 Acapulco/El Torito (8%) 25 American Girl (9%) 25 or 100 Applebees (8%) 25 Barnes & Noble/B.Dalton (9%) 10 or 25 (7%) 25 Bass Pro Shops (9%) 25 or 100 Black Angus (12%) 25 Bath & Body Works (13%) 10 or 25 Buca de Beppo (8%) 25 Bed, Bath & Beyond (7%) 25 or 100 Buffalo Wild Wings (8%) 10 or 25 Best Buy (3%) 25 or 100 (4%) 10 Build-A-Bear Workshop (8%) 25 California Pizza Kitchen (8%) 10 Burlington Coat Factory (8%) 25 Carl's (5%) 10 Children's Place (12%) 25 Cheesecake Factory (5%) 25 Claire's (9%) 10 Chevy's (8%) 25 Container Store (9%) 25 or 100 Chili's/Macaroni Grill (11%) 25 Crate and Barrel (8%) 25 or 100 (10%) 10 Eddie Bauer (10%) 25 Chuck E. Cheese (8%) 10 Foot Locker (9%) 25 Claim Jumper (9%) 25 GameStop (3%) 25 Coco's (8%) 10 Gap/Navy/Banana Republic (14%) 25 or 100 Coffee Bean & Tea Leaf (9%) 25 Groupon.com (7%) 25 (8%) 10 Guitar Center (4%) 25 Dave and Buster's (13%) 25 Gymboree (13%) 25 (4%) 10 Home Goods (7%) 25 or 100 Domino's Pizza (8%) 10 iTunes (5%) 15 or 25 Einstein Bros. Bagels (10%) 10 J.Crew (13%) 25 Sub Total 1 Sub Total 2

2014-15 - page 2 Denom Qty Total Calculate total # of certificates JoAnn Fabrics (8%) 25 and total dollar value of your order LL Bean (16%) 25 or 100 QTY TOTAL $ Lands' End (16%) 25 or 100 Sub Total 1 Marshalls/TJ Maxx (7%) 25 or 100 Sub Total 2 Michaels (4%) 25 Sub Total 3 Office Depot (4%) 25 or 100 Office Max (5%) 25 or 100 GRAND TOTAL Oriental Trading (9%) 25 Payless Shoes (13%) 20 Pier 1 (9%) 25 Pottery Barn/Wm.Sonoma (8%) 25 or 100 Cash Check # Method of Restoration Hardware (12%) 25 or 100 payment Ross Dress for Less (8%) 25 See's Candies (20%) 18 Sephora (5%) 20 Staples (5%) 25 Talbot's (13%) 25 Toys/Babies R Us (3%) 20 ***Will pick up at (circle one):

Dev.Dept. BYH Preschool

SPORTING GOODS Big 5 (8%) 25 Dick's Sporting Goods (8%) 25 REI (8%) 25 Sports Authority (8%) 25 GAS STATIONS Important Notes Arco (1.5%) 50 or 100 Arco (2.5%) 250 * Orders must be received by 3:30 p.m. on Chevron (1%) 50 Monday afternoon for Friday pickup! Shell (2.5%) 50 * Make checks payable to "PCS Scrip"

Gift Card wrappers - 10 pack (10%) 2

Only Place in Town (20%) 25 Jack's Cleaners (10%) 25 THANKS FOR YOUR SUPPORT !!!

Sub Total 3

You may also go to the website www.glscrip.com and look under 'Retailers'. If you find another type of scrip that is not on our order form, you may add it in a blank space and we will order it for you (same is true for other available denominations).

*You get one hour of MVP credit for every $250 worth of scrip you order (up to ½ of your required hours)!

8/27/2014