Great Lakes Scrip Order Form

Please complete the order form and include a check made out the Snowfox Swim Team. Orders will be taken each Monday from 7-8 pm at the YWCA. Filled orders will be available the following Monday. If you need to make other arrangements for placements or pick up please call Lisa Bean 977-6385 or 351-7144 Cell. Orders not accompanied by payment will not be placed.

Retailer	Denomination		Quantity	Total











Total Order Please make check in this amount payable to Snowfox Swim Team
Date Ordered		Date Delivered
Ck #		Delivered To

I authorize the following person to pick up my Scrip Order. Neither Snowfox nor Great Lakes Scrip can replace lost cards.

Person Authorize to pick up your order_____________________________________

Your Signature________________________________________________________