LCS Scrips Order Form
Orders will be filled and your cards will be given to your child at the end of the day, unless you specify differently. LCS is not responsible for lost or stolen cards after they are given to your child. If you have any questions, Aimee can be reached at 303-919-7232 or scrips@longmontchristian.org
Your Name
Your answer
Phone Number
Your answer
Email Address
Your answer
Child's Name
Your answer
Child's Teacher
Your answer
Check $ Total (Please do not send cash)
Your answer
Check # (Please make check payable to LCS)
Your answer
How would you like to receive your cards?
Required
Apparel
1
2
3
4
5
6 or More
JC Penny ($25)
Kohls Dept Store (can be used to pay on account) ($25)
Kohls Dept Store (can be used to pay on account) ($100)
For quantities of 6 or more
Your answer
Dining
Casual and On the Go
1
2
3
4
5
6 or More
Chili's, On The Border, Magiano's & Macaroni Grill ($25)
Chipotle Mexican Grill ($10)
Dairy Queen ($10)
Einstein's Bagels ($10)
Inta' Juice ($10)
Noodles ($10)
Panera Bread ($10)
Papa John's Pizza ($10)
Papa Murphy's Pizza ($10)
Qdoba Mexican Grill ($25)
Red Robin ($25)
Smashburger ($10)
Starbuck's Coffee ($10)
Starbuck's Coffee ($25)
Subway ($10)
Taco Bell ($10)
Texas Roadhouse ($25)
Wendy's ($10)
Ziggi's Coffee House ($10)
For quantities of 6 or more
Your answer
Grocery
1
2
3
4
5
6 or more
King Soopers (RELOADABLE AT STORE) ($10)
Lucky's Market ($25)
Lucky's Market ($50)
Lucky's Market ($100)
Safeway (RELOADABLE AT STORE) ($10)
Safeway (NON-RELOADABLE) ($25)
Safeway (NON-RELOADABLE) ($100)
Sprouts Farmer's Market ($25)
Sprouts Farmer's Market ($50)
Sprouts Farmer's Market ($100)
Vitamin Cottage/Natural Grocers ($25)
Vitamin Cottage/Natural Grocers ($50)
Vitamin Cottage/Natural Grocers ($100)
For quanities of 6 or more
Your answer
Entertainment
1
2
3
4
5
6 or more
AMC Theaters (Flatiron, Orchards, Westminster) ($25)
Century Theaters (Boulder) ($25)
I-Tunes ($15)
Regal Theaters (Longmont) ($25)
For quantities of 6 or more
Your answer
Home Improvement
Can be special ordered in larger incerements
1
2
3
4
5
6 or more
Home Depot ($25)
Lowe's ($25)
For quantities of 6 or more
Your answer
Various
1
2
3
4
5
6 or more
Bed Bath & Beyond ($25)
Dick's Sporting Goods ($25)
PetSmart ($25)
Target ($10)
Target ($25)
Target ($50)
Target ($100)
Wal-Mart/Sam's Club ($25)
Wal-Mart/Sam's Club ($100)
For quantities of 6 or more
Your answer
Grand Total:
Your answer
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