Provide us with your current eScrip Supporter ID# and your name. (Required Information)

Your Current eScrip Supporter ID# Your Name Phone#

Add/Change Form Fill in only the areas you want changed or updated. To change your contact information: To add/change your group(s): It’s important to make sure: Keep current Remove current * Your email address is current. group and group and Group ID# add this group add this group * You have registered all of your Street Address credit/debit and grocery club cards. * Your contact information is current. City State Zip

99% of all eScrip merchants accept Phone Number Credit and/or Debit Cards. Watch your everyday purchases add up! To add/change your email address:

Update your account online! Email Address* It's quick, convenient–and you *Email Address required maximize your contributions! To add or update your credit/debit & grocery club cards: (allow 1 week processing) Card Type Card Number Program details at: www.escrip.com

If you don't have online access: * Mail in the attached form. (allow 6-8 weeks process time)

Return completed form to: Grocery Club Card Type: Safeway*, Pavilions*, Vons*, Genuardi’s*, Carrs*, Dominick’s*, Adams*, Holiday, Pathmark, ShopRite, ShurSave Debit/Credit Card Type: MasterCard, VISA, American Express, Discover, Debit Cards Electronic Scrip Inc, P.O. Box 6988 Auburn, CA 95604-6988 *Some merchants not available in all locations. Visit www.escrip.com for program details. Certain merchants may have specific “group type” requirements in order to qualify for contributions, visit www.escrip.com and go to merchant search for details. addchange_form_all_2010_05_25