Thomas Jefferson Memorial Church - Unitarian Universalist

Script Order Form

Your Name(required)
Address(required)
City(required)
State(required)
Zip(required)
Phone(required)
Email(valid email required)
INDICATE METHOD TO RECEIVE SCRIP:
Medhod(required)

Giant Cards

Number $50 cards
Number $100 cards
Number $200 cards
Giant total amount $

Food Lion Cards

Number of $50 cards
Number of $100 cards
Number of $200 cards
Food Lion total amount $

Whole Foods Cards

Number $50 cards
Number $100 cards
Whole Foods total amount $

Kroger Cards

Number $50 cards
Total Kroger amount $

Integral Yoga Cards

Number $20 cards
Number $50 cards
Total Integral Yoga amount $

Rebecca's

Number $25 cards
Total Rebecca's amount $

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Please fill out and print the form and make check payable to TJMC- Scrip

-To get your Scrip right away, take order form and check to the Scrip table on Sundays.
-To pre-order, place order form and check in the Scrip church mailbox (#1), or mail them to:
Trudy Rohm, 1774 Old Brook Rd, Charlottesville, VA 22901

Thomas Jefferson Memorial Church - Unitarian Universalist

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