SCRIP Order Submission
You can use this form to submit a SCRIP order which we can prepare for you before you arrive in the office. Please give us a couple hours before you come to pick up your order, as it will take a little time to prepare your order. Payment can be made when you pick up your order, and is required before receiving your order.
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Your name *
Phone Number *
Where will you pick up SCRIP? *
Where should we apply the benefit? (Type family name into "Other", if applying to tuition) *
Amazon (2.25%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
American Eagle Outfitters (10%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Applebee's (8%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Arby's (8%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Baker's Square (8%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Barnes & Noble (9%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Bath & Body Works (13%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Bed, Bath & Beyond (7%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Best Buy (6%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Beth's Twin Bluffs Café (5%, please write your Gift Certificate amount and how many Certificates you would like)
Buckle (8%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Buffalo Wild Wings (13%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Cabela's (8%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
Caribou Coffee (6%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Chipotle (10%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Culver's (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Dairy Queen (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
$20
Clear selection
Dick's Fresh Market (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
$50
$100
$200
Clear selection
Fazoli's (7%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Fleet Farm (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
Fresh Wok (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
Clear selection
Front Porch (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
GameStop
1
Zero - Clicked by accident
$25
Clear selection
GAP / Banana Republic / Old Navy (9%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Handy Mart (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Herb + Arrow
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Hill's Hardware Hank (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
$100
Clear selection
Home Depot (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
HyVee (3%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
Interstate Building Supply (3%)
iTunes (5%)
1
2
3
4
5
Zero - Clicked by accident
$15
Clear selection
JCPenney (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
J&J BBQ (10%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Kohls (4%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Kwik Trip (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
$50
$100
$200
Clear selection
Land's End (16%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Lowe's (4%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Macy's (10%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Maurice's (7%)
1
2
3
4
5
Zero - Clicked by accident
$20
Clear selection
McDonald's (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Menards (3%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
Michael's (4%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Olive Garden (9%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Panera Bread (9%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Papa Murphy's (8%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Pioneer Club (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Pizza Hut (8%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Pure Identity Salon & Spa (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
Red Lobster (8%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Riverboat Lanes (10%)
1
2
3
4
5
Zero - Clicked by accident
$10
$20
Clear selection
Scheels All Sport (5%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Shutterfly (9%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Silver Star (varies, see below)
1
2
3
4
5
Zero - Clicked by accident
$25 (5%)
$100 (10%)
Clear selection
Slippery's (10%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
Clear selection
Starbucks (7%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Subway (6%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
SVJ Creative Designs (10%, please write your Gift Certificate amount and how many Certificates you would like)
Taco Bell (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
Clear selection
Target (2%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
$100
Clear selection
Texas RoadHouse (8%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
The Olde Triangle (10%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
Clear selection
TJ Maxx / Marshalls (7%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
Town & Country Café (5%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
Clear selection
Under Armour (9%)
1
2
3
4
5
Zero - Clicked by accident
$25
Clear selection
VISA, prepaid card (1.25%)
1
2
3
4
5
Zero - Clicked by accident
$50
$100
Clear selection
Wabasha Warehouse Liquor (4%)
1
2
3
4
5
Zero - Clicked by accident
$10
$25
Clear selection
Walgreens (6%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100
Clear selection
Walmart / Sam's Club (2%)
1
2
3
4
5
Zero - Clicked by accident
$25
$100