Great Bridge Band Parent Association Scrip Order Form

Name: ___________________________ Order date: _________________

Band Member Being Sponsored: __________________ (okay to say none)

Phone Number: __________________ Email address _______________

For more information about Scrip, visit glscrip.com or gbhsband.org

Retailer lists and specials are available online. Glscrip.com can be accessed via the gbhsband.org website. The band website includes scrip available only through the band association.

Please make checks payable to Great Bridge Band Parents Association. No cash can be accepted. Order forms can be dropped in the locked mailbox in the band room by 12pm on deadline date.

Retailer Name of Scrip Desired	Card $$ Value	Quantity	Subtotal	% back	Wildcat Dollars earned (50% of discount)
TOTAL CARDS & COST

Credit, if used: _______________

(office only)Check verified: ____/____ Check amount: ______________ Check #________

Questions: Contact Dawn Bell 546-7812 or dnbell3@cox.net; Donna Murtha 389-5380 or dmurtha3@cox.net; Terri Chapman 482-2278, or gumbyabc@aol.com; or Janet Donovan 546-5624 or dnjdonovan@cox.net.

Please do not sign below until you verify your order at pick up!

Order Verified and Picked By: ___________________________Date________

Order Verified and Distributed By: ________________________Date________