SCRIP Family Order Form									12/3/2007
Name						Total Purchase		Date:
Apparel & Accessories						Entertainment
	Product	%	Qty	Total			Product	%	Qty	Total
133	Claire's $10	9%		$		128	Family Video $5	5%		$
265	Fashion Bug $25	6%		$		261	TC Cinema gift card $10	10%		$
146	Maurices $20	7%		$		258	Recreation Lanes $50 coupon for $25			$
150	Perina's $10	10%		$		Gas & Auto
151	Perina's $25	10%		$		105	Citgo $10	5%		$
Department Store						106	Freedom Gas $25	5%		$
148	JCPenney  $25	6%		$		107	Freedom Gas $50	5%		$
149	JCPenney $100	6%		$		192	Holiday Stationstores $25	4%		$
Dining Casual						266	Holiday Stationstores $50	4%		$
116	El Capitan $25	10%		$		248	Napa  Auto  $Your Amt	3%		$
117	Fontana's $25	10%		$		Grocery
120	Moose Jackson $10	10%		$		101	Econo Foods $10	3%		$
121	Olive Garden                            Red Lobster $25	9%		$		102	Econo Foods $25	3%		$
122	Pizza Hut $10	9%		$		Home Decor
Dining - On The Go						152	Presents of Mine $20	10.00%		$
255	Arby's $10 Gift Card	8%		$		Home Improvement
112	Burger King $10	4%		$		143	Home Depot $25	3%		$
110	A & W $5	10%		$		144	Home Depot $100	3%		$
111	A & W $10	10%		$		147	Northern Carpets	2%		$
262	Cousins $10	9%		$		154	Rocconi Ace  $Your Amt	5%		$
114	Dairy Queen $5	15%		$		239	True Value $Your Amt	3%		$
115	Domino's  $5	5%		$		Specialty Retailer
118	KFC $5	9%		$		139	The Holy Store $5	7.00%		$
119	McDonald's $5	5%		$		140	The Holy Store $10	7.00%		$
166	Starbucks $10	7%		$		141	The Holy Store $25	7.00%		$
124	Subway $5	20%		$		153	Richardson Jewelers	3.00%		$
125	Taco Bell $5	10%		$