Easy Scrip Order Form - All Other Area
Please remember, when giving Scrip or Gift Certificates, tax & tips are to be paid in CASH - please be generous with gratuities!

Select the Scrip Amount in the second column next to the Barter Club Member's name and then choose the Quantity from the third column. Leave all others at "0".

Limited amount (usually one per month)
Can use barter slips as well

Barter Member	Scrip Amount	Quantity
49er Family Fun Park	0 $35	0 1 2 3 4 5 6
Belle Beauty Supply	0 Certificate $25 Certificate $50	0 1 2 3 4 5 6
California Sun Centers	0 3 Months 6 Months 9 Months 12 Months	0 1 2 3 4 5 6
Cattail Flowers & Gifts	0 Certificate $35 Certificate $50	0 1 2 3 4 5 6
Dawn’s Office Supply & Hallmark	0 $25	0 1 2 3 4 5 6
Depoe Bay Coffee	0 $25	0 1 2 3 4 5 6
Edelweiss  - Downtown	0 $35	0 1 2 3 4 5 6
El Sombrero Taqueria	0 $35	0 1 2 3 4 5 6
Fosco’s Italian Café & Market Place	0 $35	0 1 2 3 4 5 6
Foster Freeze (Auburn)	0 $35	0 1 2 3 4 5 6
La Perla Bistro (Carmichael)	0 Certificate $25 Certificate $50	0 1 2 3 4 5 6
Larry & Lena’s Take-U-Bake (Lake Wildwood)	0 $35	0 1 2 3 4 5 6
Lorenzo’s (Loomis)	0 $35	0 1 2 3 4 5 6
Los Cabos Grill (Roseville)	0 $35	0 1 2 3 4 5 6
Mark & Monica's Family Pizza (Lincoln & Carmichael)	0 $35 $50	0 1 2 3 4 5 6
Newcastle Preserves & Gourmet Foods	0 $25	0 1 2 3 4 5 6
Petals & Sweets	0 $35	0 1 2 3 4 5 6
Pizza Express (Take Out Only)	0 Certificate $35	0 1 2 3 4 5 6
Raspberry Hill Golf Course	0 $35	0 1 2 3 4 5 6
Sierra Cab	0 $10 $20	0 1 2 3 4 5 6
Sierra Saw	0 $50	0 1 2 3 4 5 6
Spee-Dee Oil (Basic oil change & inspection)	0 $36	0 1 2 3 4 5 6
Smog Inspection	0 $60	0 1 2 3 4 5 6
Sun River Clothing Company	0 Certificate $25 Certificate $50	0 1 2 3 4 5 6
Your Name: Company Name: Account Number: Phone Number: Email Address: If one or more of your Scrip orders is out of stock, do you wish to backorder? Yes No Notes or Questions:
Limited amount (usually one per month) Can use barter slips as well