UBCCC SCRIP Gift Card Order Form

Name: Campus: North South (circle one) Classroom#: Email Address: TOTAL#Gift Cards: TOTAL $ Due: Green colored boxes show the gift cards that UBCCC Helping Hands earns a higher percentage from (10% - 16%). *Don't see a retailer you want on this list? Order online at shopwithscrip.com*

Product QTY Total Product QTY TotalProduct QTY Total A-Plus Convenience Store $50 $ Buffalo Wild Wings $10 $ Dave & Buster's $25 $ aerie $25 $ Buffalo Wild Wings $25 $ Dell Computer $100 $ Amazon.com $100 $ Build-A-Bear Workshop $25 $ Denny's $10 $ Amazon.com $25 $ Burger King $10 $ Dick's Sporting Goods $100 $ AMC Theatres® $25 Burlington Coat Factory $25 $ Dick's Sporting Goods $25 $ American Eagle Outfitters $25 $ buybuyBABY $100 $ Disney $100 $ American Girl $100 $ buybuyBABY $25 $ Disney $25 $ American Girl $25 $ Cabela's $25 $ Domino's $10 $ Andersons $25 $ Carrabba's Italian Grill $25 $ Dunkin' Donuts $10 $ Applebee's $25 $ Carter's $25 $ Dunkin' Donuts $25 $ Applebee's $50 $ Children's Place $25 $ EB Games $25 $ Arby's $10 $ Chili's Grill & Bar $25 $ Express $25 $ Babies"R"Us $20.00 $ Chili's Grill & Bar $50 $ Express for Men $25 $ Banana Republic $100 $ Chipotle Mexican Grill $10 $ Exxon $50 $ Banana Republic $25 $ Christmas Tree Shops $100 $ Family Video $10 $ Barnes & Noble $10 $ Christmas Tree Shops $25 $ GameStop $25 $ Barnes & Noble $25 $ Chuck E. Cheese $10 $ Gander Mountain $25 $ Bath & Body Works $10 $ Claire's $10 $ Gap $100 $ Bath & Body Works $25 $ Cold Stone Creamery $10 $ Gap $25 $ Bed Bath & Beyond $100 $ Container Store $100 $ GNC $25 $ Bed Bath & Beyond $25 $ Container Store $25 $ Groupon.com $25 $ Best Buy® $100 $ Cracker Barrel $10 $ Guitar Center $25 $ Best Buy® $25 $ Cracker Barrel $25 $ Hallmark $25 $ Bob Evans $10 $ Crate and Barrel $100 $ HomeGoods $100 $ Bon-Ton $100 $ Crate and Barrel $25 $ HomeGoods $25 $ Bon-Ton $25 $ Crazy 8 $25 $ IHOP $25 $ Bonefish Grill $25 $ CVS Pharmacy $100 $ iTunes® $15 $ Boston Market $10 $ CVS Pharmacy $25 $ iTunes® $25 $ Bravo Cucina Italiana $25 $ Dairy Queen $10 $ J. Crew $25 $

Make Checks Payable To: UBCCC (Write "SCRIP" in memo) 1 Product QTY Total Product QTY Total Product QTY Total JCPenney $100 $ Papa John's Pizza $10 $ Taco Bell $10 $ JCPenney $25 $ Payless Shoes $20.00 $ Talbots $25 $ Jo-Ann Fabric Stores $25 $ PBteen $25 $ Target $100 $ Kmart $25 $ Pep Boys $20.00 $ Target $25 $ Kmart $50 $ PetSmart $25 $ Target $50 $ Kohl's $100 $ Pier 1 Imports $25 $ TGI Fridays $25 $ Kohl's $25 $ Pizza Hut (Not AK or HI) $10 $ The Home Depot $100 $ L.L.Bean $100 $ Pottery Barn $100 $ The Home Depot $25 $ L.L.Bean $25 $ Pottery Barn $25 $ Tim Hortons $10 $ Lady Foot Locker $25 $ Pottery Barn Kids $100 $ Toys"R"Us $100 $ Land of Nod $25 $ Pottery Barn Kids $25 $ Toys"R"Us $20.00 $ Lands' End $100 $ Rainforest Cafe $25 $ ULTA $25 $ Lands' End $25 $ Red Lobster ® $25 $ Walgreens $100 $ Lands' End Kids $25 $ Red Robin $25 $ Walgreens $25 $ Lane Bryant $25 $ Regal Theatres $25 $ Walmart $100 $ Limited $25 $ Rite Aid $25 $ Walmart $25 $ Lord & Taylor $25 $ Ruby Tuesday $25 $ Wendy's $10 $ Lowe's $100 $ Sally Beauty Supply $25 $ West Elm $25 $ Lowe's $25 $ Sam's Club $100 $ Williams-Sonoma $100 $ Macy's $100 $ Sam's Club $25 $ Williams-Sonoma $25 $ Macy's $25 $ Sears $100 $ Zappos.com $25 $ Marshalls $100 $ Sears $25 $ Marshalls $25 $ Sears Auto Service Center $100 $ Men's Wearhouse $25 $ Sears Auto Service Center $25 $ Michaels $25 $ Sears Auto Service Center $250 $ Mobil $50 $ Sephora $20.00 $ NOOK by Barnes & Noble $10 $ Shutterfly $25 $ NOOK by Barnes & Noble $25 $ Spafinder Wellness 365 $25 $ Office Depot / Office Max $25 $ Staples $100 $ Old Navy $100 $ Staples $25 $ Old Navy $25 $ Starbucks $10 $ Olive Garden ® $25 $ Starbucks $25 $ Omaha Steaks $25 $ SUBWAY® Restaurants $10 $ Oriental Trading Company $25 $ SUBWAY® Restaurants $50 $ OshKosh $25 $ Sunoco $250 $ Outback Steakhouse $25 $ Sunoco $50 $ P.F. Chang's China Bistro $25 $ Supercuts $25 $ Panera Bread $10 $ T.J. Maxx/Marshalls/HomeGoods $100 $

Make Checks Payable To: UBCCC (Write "SCRIP" in memo) 2