Great Lakes Scrip Center Ordering Form for Lightstreet UM Church
Name:_____________________________ Date:_________________
Phone:___________________ Email:__________________________
Orders received each Sunday will be processed and available the following Sunday. Pay with cash or checks. Make checks payable to: LUMC Scrip Pro. Contact Pam Szilagyi (389-1083) or Amy Dent (458-4299) with questions. Check on-line at www.ShopWithScrip.com for additional information.
Gift Card: Quantity: Total: Gift Card: Quantity: Total:
Example:
_Giant _____ _2@100_ _$200_ ____________ ________ _______
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Total Cards: ______
Cash Total:_________
Check Total & Check Number:_____________
Scrip Committee Member Intials:________