Scrip Standing Order Form

Scrip Standing Order Form

Please verify your order and let us know of any discrepancies immediately by e-mailing us at [email protected] PLEASE RETURN EMPTY ENVELOPES Name: FOR NEXT STANDING ORDER Card Quantity Card Quantity Card Quantity BP $50 Amazon.com $25 Applebee's $25 BP $100 Barnes & Noble $25 Applebee's $50 Exxon/Mobil $50 CVS/pharmacy $25 Buffalo Wild Wings $25 Kwik Trip $25 GNC $25 Chili's/Maggiano's $25 Kwik Trip $50 Klinke $25 Cousins Subs $10 Kwik Trip $100 Kohl's $25 Culver's $10 PDQ $50 Kohl's $100 Culver's $25 PDQ $100 Land's End $25 Denny's $10 Good Harvest $25 Marcus $10 Noodles & Company $10 Good Harvest $100 Marcus $25 Olive Garden/Red Lobster $25 Meijer $25 Target $25 Outback/Carraba's $25 Meijer $50 Target $50 Panera Bread $10 Meijer $100 Target $100 Panera Bread $25 Pick N Save $25 Walgreen's $25 Papa Murphy's $10 Pick N Save $50 Walmart/Sam's $25 Starbucks $10 Pick N Save $100 Walmart/Sam's $100 Starbucks $25 Piggly Wiggly $25 Walmart/Sam's $250 Subway $10 Piggly Wiggly $50 Sendik's - Balistreri $25 Sendik's - Balistreri $100 Sendik's - Brookfield $100 Sentry $10 Sentry $50 Stop & Shop/Peapod $100 Woodman's $50 Woodman's $100 Order Total $ Thank you for your support of this great fundraiser!! Please verify your order and let us know of any discrepancies immediately by e-mailing us at [email protected] PLEASE RETURN EMPTY ENVELOPES Name: FOR NEXT STANDING ORDER Card Quantity Card Quantity Card Quantity BP $50 Amazon.com $25 Applebee's $25 BP $100 Barnes & Noble $25 Applebee's $50 Exxon/Mobil $50 CVS/pharmacy $25 Buffalo Wild Wings $25 Kwik Trip $25 GNC $25 Chili's/Maggiano's $25 Kwik Trip $50 Klinke $25 Cousins Subs $10 Kwik Trip $100 Kohl's $25 Culver's $10 PDQ $50 Kohl's $100 Culver's $25 PDQ $100 Land's End $25 Denny's $10 Good Harvest $25 Marcus $10 Noodles & Company $10 Good Harvest $100 Marcus $25 Olive Garden/Red Lobster $25 Meijer $25 Target $25 Outback/Carraba's $25 Meijer $50 Target $50 Panera Bread $10 Meijer $100 Target $100 Panera Bread $25 Pick N Save $25 Walgreen's $25 Papa Murphy's $10 Pick N Save $50 Walmart/Sam's $25 Starbucks $10 Pick N Save $100 Walmart/Sam's $100 Starbucks $25 Piggly Wiggly $25 Walmart/Sam's $250 Subway $10 Piggly Wiggly $50 Sendik's - Balistreri $25 Sendik's - Balistreri $100 Sendik's - Brookfield $100 Sentry $10 Sentry $50 Stop & Shop/Peapod $100 Woodman's $50 Woodman's $100 Order Total $ Thank you for your support of this great fundraiser!!.

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