NAME __________________			PHONE #_____________			DATE ____________
		PURCHASE			Scrip Purchase Sheet
Vendor	Value	Number	Amount
Applebys	25
Bath&Bdy Wks	10				Total Order Amount$_______
	25				Check Amount$_______
Blondie's III	5				Cash Amount$_______
Borders Books	10
Burger King	5				Make Checks Payable to
Culver's	5				Friends Scrip
Dairy Queen	5
Fazoli	5
Gehrke Floral	10				SPECIAL ORDERS
	20				Kmart by special order only
Gundersons	5				Scrip is available from many vendors
	10				that are not listed on the puchase
Hardee's	5				sheet to the left including:
JC Penney	25				Amazon.com, Arby's, Barnes&Noble
Kohl's	25				Best Buy, Chi Chi's, Domino's
Linen&Things	25				Pizza, Durand Theatre, Eddie
Mega P&S	25				Bauer, Foot Locker, Gander Mtn,
Mike's Smoke	10				The Gap, KFC, KayBee Toys,
Northwoods	10				Lands' End, Menard's, Office Max,
Old Navy	25				Pier 1 Imports, TCYB,
Olive G/Red Lob	25				TGI Fridays, TJ Maxx
Pamida	10				Other vendors available upon request
Panera	10				List below the items you would like
Pizza Hut	10
Ron's Castle	10				For Special Orders
Scheels	10				List below the vendor/s, amounts,
	25				and the date needed.
Shanghai Bistro	5				Be sure to include your phone
Shopko	25				number on the top line above.
Speedway	10
	25				Vendor		Amount &	Date
Subway	10						Number	Needed
Super Valu	5
	10
	25
Taco John's	5
Wendy's	10				Thank You