Great Lakes Scrip Center order form

 

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_                         ____________             ________             _______

 

_____________             ________             _______                     ____________             ________             _______

 

_____________             ________             _______                      ____________             ________             _______

 

_____________             ________             _______                      ____________             ________             _______

 

_____________             ________             _______                      ____________             ________             _______

 

_____________             ________             _______                      ____________             ________             _______

 

 

Total Cards: ______

 

                             Cash Total:_________

Check Total & Check Number:_____________

Scrip Committee Member Intials:________