LHNE - Scrip Form

LHNE SCRIP PROGRAM
Grocery/Food Stores	LHNE%	Denom	Qty Choose Qty	Total Enter Total Amount Due	Gas/Wash/Service	LHNE%	Denom	Qty Choose Qty	Total Enter Total Amount Due
HyVee*	3%	$10			Advance Auto Parts	7%	$25
HyVee*	3%	$25			Jerry's Sinclair*	5%	$25
HyVee*	3%	$50			Tom's Service - Pierce	3%	$10
HyVee*	3%	$100			Tom's Service - Pierce	3%	$25
Lou's	3%	$25			Restaurants/Food
Lou's	3%	$50			Applebees	8%	$25
Lou's	3%	$100			Arby's	8%	$10
Thriftyway Market (Tilden)	5%	$25			Burger King - Norfolk Only	10%	$5
Thriftyway Market (Tilden)	5%	$50
Thriftyway Market (Tilden)	5%	$100			Burger King	4%	$10
Oberle's Market (Winside)	5%	$10			Culver's	10%	$10
Retail/Discount Stores					Domino's Pizza	5%	$5
The Abbey	10%	$10			KFC	9%	$5
The Abbey	10%	$25			McDonald's	20%	$5
Ace Hardware	4%	$25			Michael's Cantina	10%	$10
Bath & Body Works	13%	$10			Pizza Hut	9%	$10
Bath & Body Works	13%	$25			Prenger's	10%	$10
Bomgaars	5%	$25			Prenger's	10%	$25
Bomgaars	5%	$50			Red Lobster/Olive Garden	9%	$25
Bomgaars	5%	$100			Ricardo's	10%	$10
Claire's	9%	$10			Runza	10%	$10
Hastings	5%	$5			Sports Denn	10%	$10
Hastings	5%	$10			Subway	15%	$10
Herberger's	8%	$25			Valentino's - (Norfolk Only)	10%	$10
JCPenney**	4%	$25			Valentino's - (Norfolk Only)	10%	$25
JCPenney**	4%	$100			Wendy's	4%	$10
Maurices	7%	$20			Madison Stores
Menards	3%	$25			Madison Ampride (Good on Charges)	3%	$10
Menards	3%	$100			Madison Ampride (Good on Charges)	3%	$25
Office Max	5%	$25			Madison Ampride (Good on Charges)	3%	$100
Payless Shoes	13%	$20			Madison Ampride (Good on Charges)	3%	$250
Shopko	4%	$25			Madison Food Pride	3%	$5
Shopko	4%	$50			Madison Food Pride	3%	$10
Walgreens	2%	$20			Others
WalMart	2%	$25			Mainstreet Gallery - Pierce	10%	$10, $20
WalMart	2%	$100			Tastefully Simple (Nadine A.)	10%	$10


Please Add up Totals of Column 1 Total of this column				$	Please Add Up Total of Culmn 2 Total of this column			$


*Good on all merchandise & services
**Good on store & catalog purchases, charge balances

LHNE SCRIP PROGRAM - SPECIAL ORDERS
Business	LHNE%	Denom	Qty Choose Qty	Total Enter Total Amount Due
American Eagle Outfitters	8%	$25
Banana Republic	9%	$25
Barnes & Noble/B.Dalton Bookstores	9%	$10
Bed, Bath & Beyond	7%	$25
Best Buy	2%	$25
Cabela's	11%	$25
Carlos O'Kelley	9%	$10
Cheesecake Factory	5%	$25
Chili's/Macaroni Grill	11%	$25
Chipotle's	10%	$10
Circuit City	3%	$50
Circuit City	3%	$100
Dave & Buster's	13%	$25
Denny's	9%	$10
Dillard's	9%	$25
Eddie Bauer	9%	$25
Express	13%	$25
Family Christian Stores	9%	$10
Footlocker	9%	$25
GNC	8%	$25
Old Navy/Gap/Gap Kids/Baby Gap	9%	$25
Home Depot	3%	$25
Home Depot	3%	$100
iTunes	4%	$15
Jo-Ann Fabrics	6%	$20
KB Toys	9%	$10
Kohl's	9%	$25
Kohl's	4%	$100
Limited	9%	$25
Linen & Things	8%	$25
Macy's	9%	$25
Outback Steakhouse	4%	$25
Panera Bread	9%	$10
Pier One Imports	9%	$25
Radio Shack	4%	$25
Red Robin	9%	$10
Regis Hair Salon	8%	$25
Sears	4%	$25
Starbucks	7%	$10
TGI Fridays	13%	$20
Toys/Kids/Babies-R-Us	3%	$20
Waldenbooks/Borders	8%	$10

Please Add Up Total of Special Order Total			$

Rules for special orders:
They must be prepaid
Orders are due by 10:00 a.m. on Monday
Scrip will be in by noon on Friday

For a complete list of available scrip go to Great Lakes Scrip Program


Purchaser Name:
Purchaser E-Mail

I have received the above cards & certificates and understand that my scrip purchases are not tax deductable for charitable purposes
Signature Required when You Pick-up Scrip at Freudenburg & Assoc.
Signature:			Date:


Pay when you Pick-up at Freudenburg & Assoc. Make checks payable to: Lutheran High Northeast Scrip Program

OR Contact via E-Mail at Order Scrip-scripLHNE@yahoo.com

Pick-up Scrip at:

Freudenburg and Assoc., 700 Omaha Ave, Norfolk, NE

402-371-6061

Please Call Before Picking Up Order

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