ST. RICHARDS CATHOLIC CHURCH
GIFT CERTIFICATE PROGRAM ORDER FORM
For more information, visit the Great Lakes Scrip Website
www.glscrip.com
Ordered by:
Phone number:
I am a School family
YES
NO
Date:
Check #/Cash :
Total Amount:
My order is designated for the following family:
VENDOR
IN STOCK ORDERS
AMOUNT
QTY
AMC Theaters
Bandanas
CVS Pharmacy **
Dierbergs
Dierbergs
First Watch
First Watch
Home Depot **
Kohls *
Kohls *
Lowe's **
Panera (St Louis Bread Co)**
Seven - Eleven
Seven - Eleven
Shop N Save
Shop N Save
Starbucks **
Subway **
Target
Target
Walgreens
Walmart/Sam's Club **
Walmart/Sam's Club **
VENDOR
Applebee's **
Arby's
Bob Evans
Bravo Cucina
Brio Tuscan Grill
Burger King
Buffalo Wild Wings
California Pizza
Cheesecake Factory
Chilis
Chipotle
Chuck E. Cheese
Cold Stone Creamery
Cracker Barrel
Cracker Barrel
Dave & Buster's
Denny's
Domino's Pizza
Einstein Bagels
Fazoli's
Flemings
Hardee's
Home Town Buffet
Honey Baked Ham
IHOP
Jack in the Box
KFC
Landrys Seafood **
Little Ceasars
Longhorn Steakhouse
Macaroni Grill
Maggianos
Noodle's & Co.
$25.00
$25.00
$25.00
$25.00
$100.00
$10.00
$25.00
$25.00
$25.00
$100.00
$25.00
$10.00
$25.00
$100.00
$25.00
$100.00
$10.00
$10.00
$25.00
$100.00
$25.00
$25.00
$100.00
RESTAURANT ORDERS
AMOUNT
QTY
$25.00
$10.00
$10.00
$25.00
$25.00
$10.00
$25.00
$10.00
$25.00
$25.00
$10.00
$10.00
$10.00
$10.00
$25.00
$25.00
$10.00
$10.00
$10.00
$25.00
$25.00
$10.00
$25.00
$25.00
$25.00
$10.00
$5.00
$25.00
$20.00
$25.00
$25.00
$25.00
$10.00
Seller info only (card numbers for tracking):
EARN
TOTAL $
Card number
Card Number
7%
5%
6%
5%
5%
10%
10%
4%
5%
5%
4%
9%
5%
5%
5%
5%
7%
3%
2%
2%
6%
2%
2%
EARN
8%
8%
10%
12%
12%
4%
8%
4%
5%
11%
10%
8%
8%
9%
9%
13%
7%
8%
10%
7%
8%
5%
5%
12%
8%
4%
8%
9%
8%
9%
11%
11%
8%
TOTAL $
VENDOR
O'Charleys
Olive Garden
Outback
Panera
Papa John's Pizza
Pei Wei
PF Chang
Pizza Hut
Qdoba
Quiznos
Red Lobster
Red Robin
Ruby Tuesday's
Ruth's Chris
Ryan's
Steak N Shake
Stoney River
Sweet Tomato
Taco Bell
Texas Roadhouse
TGI Friday's
Wendys
RESTAURANT ORDERS
AMOUNT
QTY
$25.00
$25.00
$25.00
$25.00
$10.00
$25.00
$25.00
$10.00
$25.00
$10.00
$25.00
$25.00
$25.00
$50.00
$25.00
$10.00
$25.00
$25.00
$10.00
$25.00
$25.00
$10.00
I will pickup my order after Mass
Please send my order through Kidmail
* These certificates can be used to pay on their charge account.
** Check GCP list for other gift card amounts that can be special orders.
Pizza Hut - For home delivery, let them know you are paying by gift card, so they can redeem cards over the phone
EARN
13%
9%
8%
9%
8%
8%
8%
8%
7%
10%
9%
9%
8%
10%
5%
8%
12%
8%
3%
8%
9%
4%
TOTAL $
RETAIL STORE ORDERS
AMOUNT
QTY
$25.00
$25.00
American Eagle Outfitters
$25.00
AutoZone
$25.00
B Dalton **
$10.00
Babies R Us
$20.00
Banana Republic
$25.00
Barnes & Noble **
$10.00
Bass Pro Shop
$25.00
Bass Pro Shop
$100.00
Bath & Body Works
$10.00
Bath & Body Works
$25.00
Bed Bath & Beyond
$25.00
Best Buy **
$25.00
Best Buy **
$100.00
Brooks Brothers
$25.00
Buckle
$25.00
Build-A-Bear
$25.00
Cabela's
$25.00
Cabela's
$100.00
Champs Sports
$25.00
Children's Place
$25.00
Claire's
$10.00
Crate and Barrel **
$25.00
Dick's Sporting Goods **
$25.00
Dillard's **
$25.00
Disney **
$25.00
Dress Barn
$25.00
Eddie Bauer
$25.00
$25.00
Fashion Bug
Finish Line
$25.00
Footlocker
$25.00
Footaction USA
$25.00
Game Stop
$25.00
Gap
$25.00
GNC
$25.00
Gordmans
$25.00
Great Clips
$25.00
Gymboree
$25.00
Hallmark
$25.00
Home Depot **
$100.00
HomeGoods **
$25.00
Icing
$10.00
iTunes
$15.00
iTunes
$25.00
J Crew
$25.00
J Jill
$25.00
JC Penney **
$25.00
Jiffy Lube
$30.00
JoAnn Fabrics
$25.00
Journeys (incl Kidz)
$25.00
K Mart **
$25.00
L L Bean **
$25.00
Land's End **
$25.00
Limited
$25.00
Lowe's Hardware **
$100.00
Macy's **
$25.00
Marshalls **
$25.00
VENDOR
Aeropostale
Amazon **
EARN
7%
4%
10%
8%
9%
1.5%
14%
9%
9%
9%
13%
13%
7%
3%
3%
16%
8%
8%
11%
11%
9%
12%
9%
8%
8%
9%
2%
8%
10%
6%
10%
9%
9%
3%
14%
8%
7%
8%
13%
4%
4%
7%
9%
5%
5%
13%
8%
5%
8%
6%
10%
4%
15%
16%
9%
4%
10%
7%
TOTAL $
RETAIL STORE ORDERS
VENDOR
AMOUNT
QTY
Men's Warehouse
$25.00
Michael's
$25.00
Nike
$25.00
Nieman Marcus
$50.00
Office Depot **
$25.00
Office Max **
$25.00
Old Navy
$25.00
Overstock.com
$25.00
Payless Shoes
$20.00
PetSmart
$25.00
Pier I
$25.00
Pottery Barn **
$25.00
Radio Shack
$25.00
Restoration Hardware
$25.00
Sally Beauty Supply
$25.00
Sears **
$25.00
Sephora
$20.00
Shutterfly
$25.00
Sports Authority **
$25.00
Staples **
$25.00
Sunglass Hut
$25.00
Talbots
$25.00
The Container Store **
$25.00
TJ Maxx **
$25.00
Toys R Us
$20.00
Wet Seal
$25.00
White Barn Candle **
$25.00
Whole Foods
$25.00
$25.00
Williams Sonoma **
VENDOR
Avis
Best Western **
Big Cedar Lodge **
BP **
Budget
Chevron **
Circle K
Clarion Hotels**
Comfort Inn / Suites **
Courtyard Marriott **
Exxon **
Fairfield **
Hyatt **
Mariott **
Mobil **
Residence Inn **
Shell **
SpringHill Suites **
TRAVEL ORDERS
AMOUNT
QTY
$50.00
$25.00
$100.00
$50.00
$50.00
$50.00
$25.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$50.00
$25.00
$50.00
EARN
8%
4%
12%
12%
4%
5%
14%
8%
13%
4%
9%
8%
4%
12%
12%
4%
4%
9%
8%
5%
12%
13%
9%
7%
1.5%
5%
13%
3%
8%
TOTAL $
EARN
8%
12%
9.0%
1.5%
8%
1.5%
1.5%
4%
4%
8%
1.5%
8%
9%
8%
1.5%
8%
2.5%
8%
TOTAL $
Seller info only (card numbers for tracking):
Vendor
Card Number
Vendor
Card number
Vendor
Card Number