Arcadia Educational Foundation

Longley Way Elementary

SCRIP Order Form

Specialty Store Scrip

Donation

Denominations

Quantity Ordered

Order $ Total

AMC Theater

7%

$25

ARCO

2%

$50

ARCO

2%

$100

Baja Fresh

7%

$25

Bath and Body Works

13%

$10

Bath and Body Works

13%

$25

Bed, Bath & Beyond

7%

$25

Best Buy

3%

$25

Best Buy

3%

$100

Borders Book Store

9%

$10

Borders Book Store

9%

$25

California Pizza Kitchen

4%

$10

Cheesecake Factory

5%

$25

Chili's, Macaroni Grill

11%

$25

Gap/Banana Republic/Old Navy

9%

$25

Home Depot

4%

$25

Home Depot

4%

$100

Home Depot*

4%

$500*

Honey Baked Ham

12%

$10

Jamba Juice

7%

$10

KFC

9%

$5

Macys

10%

$25

Macys

10%

$100

Marshall's/TJ Maxx

7%

$25

Office Depot

4%

$25

Outback/Roy's

5%

$25

See's Candy

25%

$15.60

Smart & Final

3%

$25

Smart & Final

3%

$50

Starbucks

7%

$10

Starbucks

7%

$25

Toys R Us/Babies R Us

1.5%

$20

William Sonoma/Pottery Barn

8%

$25

TOTAL

$

* Home Depot $500 cards only ordered upon special request.  Please allow about 3 weeks for delivery.

Grocery Store Scrip

Donation

Denomination

Order Amount

Order Total

99 Ranch

5%

$10

99 Ranch

5%

$20

Albertson's

4%

$25

Albertson's

4%

$100

Arcadia Super Market

5%

$25

Arcadia Super Market

5%

$50

Arcadia Super Market

5%

$100

Henry's Market

3%

$25

Hong Kong Market

6%

$20

Howies San Gabriel

5%

$10

Howies San Gabriel

5%

$20

Safeway/Vons/Pavilions

4%

$25

Safeway/Vons/Pavilions

4%

$100

Whole Foods

5%

$50

Whole Foods

5%

$100

Parent Name

Date

Student Name

Phone

Grade/Teacher's Name

Email address

Total Order $

Additional order forms can be found at the Front Office.

Or contact Nancy at gustafsson@netzero.com

Attach cash or check payable to "AEF" and

For Office Use Only

write "Longley Way/Student name" in Memo

Received by

Sorry, no credit cards

Date

Check #

Amount

 $