Complete list of retailers/values: www.glscrip.com/retailerlist Total Due in All Columns $______

Customer Name ______ Page 3

Apparel & Accessories
Product / % / Qty / Total
American Eagle Outfitters $25 / 9.0% / $
Brooks Brothers $25 / 16.0% / $
Burlington Coat Factory $25 / 8.0% / $
Casual Male Big & Tall $25 / 9.0% / $
Claire's $10 / 9.0% / $
Columbia Sportswear $50 / 12.0% / $
Crazy 8’s $25 / 13.0% / $
Dennis Uniforms $20 / 5.0% / $
Dress Barn $25 / 8.0% / $
Eddie Bauer $25 / 10.0% / $
Express $25 / 10.0% / $
Fashion Bug $25 / 6.0% / $
Finish Line $25 / 10.0% / $
Ft. Locker $25 / 9.0% / $
Fossil $50 / 12.0% / $
Gap/Banana/Old Navy $25 / 14.0% / $
Gymboree $25 / 13.0% / $
J. Crew $25 / 13.0% / $
J.Jill $25 / 8.0% / $
Joseph A Bank $25 / 10.0% / $
Journey’s $25 / 10.0% / $
Lands' End $25 / 16.0% / $
Lands' End $100 / 16.0% / $
Limited $25 / 9.0% / $
Maurices $20 / 7.0% / $
Men's Wearhouse $25 / 8.0% / $
Motherhood Maternity/
Pea in the Pod $25 / 8.0% / $
Payless Shoes $20 / 13.0% / $
Ross Dress for Less $25 / 8.0% / $
Shoe Carnival $25 / 5.0% / $
Steve & Barry $25 / 6.0% / $
Talbots $25 / 11.0% / $
The Children's Place $25 / 12.0% / $
Wet Seal $25 / 5.0% / $
Department Store
Product / % / Qty / Total
Andersons $25 / 4.0% / $
Andersons $100 / 4.0% / $
Belk Dept Store $25 / 7.0% / $
Bloomingdale's $25 / 12.0% / $
Bloomingdale's $100 / 12.0% / $
Boscov's $25 / 8.0% / $
Dillard's $25 / 9.0% / $
JCPenney $25 / 5.0% / $
JCPenney $100 / 5.0% / $
Kohl's Dept Store $25 / 4.0% / $
Kohl's Dept Store $100 / 4.0% / $
Lord & Taylor $25 / 8.0% / $
Macy's/Federated $25 / 10.0% / $
Macy's/Federated $100 / 10.0% / $
Neiman Marcus $50 / 12.0% / $
Nordstrom $25 / 6.0% / $
Nordstrom $100 / 6.0% / $
Saks Fifth Avenue / 12.0% / $
Sears $25 Gift Card / 4.0% / $
Sears $100 Gift Card / 4.0% / $
Sears $250 Card / 4.0% / $
Younker's/Bon Ton/ Carson Pirie Scott $25 / 8.0% / $
Dining - Casual
Product / % / Qty / Total
Applebee's $25 / 8.0% / $
Applebee’s $50 / 8.0% / $
Baja Fresh $25 / 7.0% / $
BD's Mongolian BBQ $20 / 8.0% / $
Bertucci’s Italian Grill / 10.0% / $
Bob Evans $10 Card / 10.0% / $
Boston Market $10 / 12.0% / $
Buca di Beppo $25 / 8.0% / $
Buffalo Wild Wings $10 / 8.0% / $
Buffalo Wild Wings $25 / 8.0% / $
Calif Pizza Kitchen $10 / 8.0% / $
Carlos O'Kelly $10 / 9.0% / $
Carrow's $10 / 8.0% / $
Charlie Brown's $25 / 8.0% / $
Cheesecake Factory $25 / 5.0% / $
Chili's/Macaroni Grill/
Maggiano’s/On the Border $25 / 11.0% / $
Chuck E Cheese $10 / 8.0% / $
Claim Jumper $25 / 8.0% / $
Coco's $10 / 8.0% / $
Cracker Barrel $10 / 9.0% / $
Dave & Buster's $25 / 13.0% / $
Denny's $10 / 7.0% / $
Eat 'n Park $10 / 10.0% / $
Hard Rock Café $25 / 10.0% / $
Islands Rest $25 / 8.0% / $
Longhorn Steakhouse $25 / 9.0% / $
Lou Malnati's $10 / 8.0% / $
Noodle's & Co. $10 / 8.0% / $
O'Charley's $25 Card / 13.0% / $
Olga's Kitchen $20 / 8.0% / $
Outback/Carrabas/BoneFish $25 / 8.0% / $
Red Lob/Olive Garden $25 / 9.0% / $
Red Robin $25 / 9.0% / $
Ruby’s Diner $25 / 5.0% / $
Ruby Tuesday's $25 / 8.0% / $
Ryan's $5 / 7.0% / $
Smashburger $10 / 10.0% / $
SweetTomatoes $25 / 8.0% / $
Texas Roadhouse $25 / 8.0% / $
TGI Fridays $25 / 8.0% / $
Tony Packo's $25 / 14.0% / $
UNO Chicago Grill $25 / 12.0% / $
Dining - Fine
Product / % / Qty / Total
Landry's (McCormick and Schmick’s; Big Fish; Chart House; Rainforest Café…) $25 / 9.0% / $
Legal Sea Foods $25 / 13.0% / $
Lettuce Entertain $25 / 12.0% / $
P.F. Chang's $25 / 8.0% / $
Dining - On The Go
Product / % / Qty / Total
Arby's $10 Gift Card / 8.0% / $
Brueggers Bagels $10 / 5.0% / $
Burger King $10 / 4.0% / $
California Tortilla $10 / 12.0% / $
Carl's Jr $5 / 5.0% / $
Chipotle Mex. Grill $10 / 10.0% / $
Coffee Bean & Tea $25 / 9.0% / $
Cold Stone Creamery $10 / 8.0% / $
Cousins Subs $10 / 9.0% / $
D'angelos/Papa Gino $10 / 8.0% / $
Del Taco $5 / 4.0% / $
Domino's $10 / 8.0% / $
Donatos Pizza $10 / 10.0% / $
Dunkin Donuts $10 / 3.0% / $
Einstein Bros Bagels $10 / 10.0% / $
El Pollo Loco $10 / 6.0% / $
Fazoli's $25 / 7.0% / $
Great Harv’t Bread $10 / 8.0% / $
Hardee’s $10 / 5.0% / $
Jack in the Box $10 / 4.0% / $
Jamba Juice $10 / 7.0% / $
Krispy Kreme $10 / 8.0% / $
Little Caesar’s $20 / 8.0% / $
Panera Bread $10 / 9.0% / $
Panera Bread $25 / 9.0% / $
Papa John's $10 / 8.0% / $
Peet's Coffee $20 / 8.0% / $
Pick-UP Stix $25 / 12.0% / $
Pizza Hut $10 / 8.0% / $
Potbelly Sandwich Shop $10 / 8.0% / $
Qdoba $25 / 7.0% / $
Quiznos $10 / 10.0% / $
Starbucks $10 / 7.0% / $
Starbucks $25 / 7.0% / $
Subway $10 / 3.0% / $
Taco Bell $10 / 5.0% / $
Wendy's Card $10 / 4.0% / $
Discount Store
Product / % / Qty / Total
Gordman’s $25 / 7.0% / $
Kmart $25 / 4.0% / $
Kmart $50 / 4.0% / $
Shopko $25 / 2.0% / $
Target $25 / 2.5% / $
Target $100 / 2.5% / $
TJ Maxx/Marshall's $25 / 7.0% / $
TJ Maxx/Marshall's $100 / 7.0% / $
Walmart $25 / 2.0% / $
Walmart $100 / 2.0% / $
Walmart $250 / 2.0% / $
Electronics & Office
Product / % / Qty / Total
Best Buy $25 / 4.0% / $
Best Buy $100 / 4.0% / $
Best Buy $250 / 4.0% / $
Game Stop $25 / 3.0% / $
Office Depot $25 / 4.0% / $
Office Max $25 / 5.0% / $
RadioShack $25 / 4.0% / $
Staples $25 Gift Card / 5.0% / $
Entertainment
Product / % / Qty / Total
AMC Theaters/Loew's $25 / 8.0% / $
AMC Theaters/Loew's Black Single Ticket $12 / 10.0% / $
AMC Theaters/Loew's Yellow Single Ticket $10 / 10.0% / $
Barnes & Noble/B.Dalt. $10 / 9.0% / $
Barnes & Noble/B.Dalt. $25 / 9.0% / $
Barnes & Noble/B Dalt $100 / 9.0% / $
Blockbuster $10 / 7.0% / $
Blockbuster Night Card $12 / 15.0% / $
Cinemark $25 Card / 4.0% / $
Goodrich Theaters $10 / 4.0% / $
Marcus Theatre $10 / 5.0% / $
Regal/United Art. $25 / 8.0% / $
Regal/UA Single Tckt. $10 / 10.0% / $
Showcase/Cin. de Lux $25 / 9.0% / $
Six Flags Universal Ticket $42.25 / 8.0% / $
Gas & Auto
Product / % / Qty / Total
Advance Auto $25 / 7.0% / $
Auto Zone $25 / 5.0% / $
BP Gas Stations $50 / 1.5% / $
Chevron $50 / 1.5% / $
Chevron $250 / 2.0% / $
Circle K $25 / 1.5% / $
Exxon/Mobil $50 / 1.5% / $
Family Express $25 / 4.0% / $
Gulf Oil $25 / 1.5% / $
Holiday Station $25 / 2.0% / $
Jiffy Lube $30 / 8.0% / $
Kwik Trip $25 / 4.0% / $
Marathon $25 / 3.0% / $
Pep Boys $20 / 4.0% / $
Royal Farms $25 / 4.0% / $
Royal Farms $100 / 4.0% / $
Quick Chek $25 / 2.0% / $
Sheetz $25 / 3.0% / $
Shell $25 / 2.0% / $
Shell $50 / 2.0% / $
Shell $100 / 2.0% / $
Sinclair $25 / 1.5% / $
Speedway $25 / 4.0% / $
Speedway Food Court $20 / 7.0% / $
Sunoco $50 / 1.50% / $
Sunoco $250 / 2.5% / $
Texaco $50 / 1.5% / $
Texaco $100 / 1.5% / $
Texaco $250 / 1.5% / $
Wawa $25 / 1.50% / $
Wawa $100 / 1.50% / $
Grocery
Product / % / Qty / Total
Albertsons/Acme $25 Card / 4.0% / $
Albertsons/Acme $100 Card / 4.0% / $
Bi-Lo Foods $10 / 4.0% / $
Cub Foods $25 / 2.0% / $
GFS Marketplace $10 / 4.0% / $
HEB/Cntrl Market $25 / 3.0% / $
P&C Foods $25 / 4.0% / $
Safeway $25 / 4.0% / $
Safeway $100 / 4.0% / $
Sentry $10 / 3.0% / $
Shaw's/Star Mrkt $25 / 4.0% / $
ShopRite $25 / 4.0% / $
ShopRite $100 / 4.0% / $
Stater Bros $25 / 5.0% / $
Giant Food $25 / 5.0% / $
Giant Food $50 / 5.0% / $
Giant Food $100 / 5.0% / $
Whole Foods $25 / 3.0% / $
Whole Foods $100 / 3.0% / $
Winn Dixie $25 / 4.0% / $
Home Decor
Product / % / Qty / Total
Bed Bath & Beyond $25 / 7.0% / $
Crate & Barrel $25 / 8.0% / $
Crate & Barrel $100 / 8.0% / $
Pier 1 $25 / 9.0% / $
Pot Barn/Will Sonoma $25 / 8.0% / $
Pot. Barn/Will Sonoma $100 / 8.0% / $
Home Improvement
Product / % / Qty / Total
Ace Hardware $25 / 4.0% / $
Home Depot $25 / 4.0% / $
Home Depot $100 / 3.0% / $
Lowe’s $20 Teacher’s Card / 4.0% / $
Lowe's $25 Gift Card / 4.0% / $
Lowe’s $100 Gift Card / 4.0% / $
Menard's $25 / 3.0% / $
Online & Mail Order
Product / % / Qty / Total
Amazon.com $25 / 3.0% / $
Amazon.com $100 / 4.0% / $
Art.com $25 / 12.0% / $
iTunes $15 / 5.0% / $
LL Bean $25 / 16.0% / $
LL Bean $100 / 16.0% / $
Omaha Steaks $25 / 9.0% / $
Overstock.com $25 / 8.0% / $
Shutterfly $25 card / 9.0% / $
Zappos.com $25 / 8.0% / $

Service

Product / % / Qty / Total
Regis Salons $25 / 8.0% / $
Spa Finder $25 / 12.0% / $
Ulta Salons $25 / 4.0% / $
Specialty Retailer
Product / % / Qty / Total
American Girl $25 / 9.0% / $
Bath & Body Works $10 / 13.0% / $
Bath & Body Works $25 / 13.0% / $
Build-A-Bear $25 / 8.0% / $
CVS Pharmacy $25 / 6.0% / $
Dream Dinners $75 / 8.0% / $
Dell Computers $100 / 4.0% / $
Family Christian Store $25 / 9.0% / $
Fannie May $10 / 25.0% / $
GNC $25 / 8.0% / $
Great Clips $25 / 8.0% / $
Guitar Center $25 / 4.0% / $
Hallmark $25 / 4.0% / $
Honey Baked Ham $25 / 12.0% / $
Jo Ann Fabrics $25 / 6.0% / $
Long's Drug $25 / 5.0% / $
Michaels $25 / 4.0% / $
Nike $25 / 12.0% / $
Oriental Trading Company $25 / 9.0% / $
PetSmart $25 / 4.0% / $
Rite Aid $25 / 4. 0% / $
Sally Beauty $25 / 12.0% / $
Sephora $20 / 4.0% / $
Service Master (TruGreen, Terminix, Home Shield, and Merry Maids) $50 / 5.0% / $
Tanger Outlets $25 / 8.0% / $
The Container Store $25 / 9.0% / $
Toys/Babies R Us $20 / 3.0% / $
Walgreens $25 / 6.0% / $
Walgreens $100 / 6.0% / $
Sporting Goods
Product / % / Qty / Total
Bass Pro Shops $25 / 9.0% / $
Big 5 Sport Goods $25 / 8.0% / $
Cabela's $25 / 11.0% / $
Dick's Sporting $25 / 5.0% / $
Dunham's Sports $25 / 8.0% / $
Gander Mountain $25 / 8.0% / $
MC Sports $25 / 8.0% / $
Rei $25 / 6.0% / $

Travel

Product / % / Qty / Total
American Airlines $100 / 8.0% / $
American Airlines $250 / 8.0% / $
Avis Car Rental $50 / 8.0% / $
BedandBreakfast.com $50 / 10.0% / $
Best Western Int'l $25 / 12.0% / $
Best Western Int'l $100 / 12.0% / $
Budget Car Rental $50 / 8.0% / $
Carnival Cruise $100 / 8.0% / $
Comfort Inn (etc) $25 / 6.0% / $
Choice Hotels / 3.0% / $
Comfort Inn (etc) $100 / 6.0% / $
Delta Airlines $250 / 4.0% / $
Delta Airlines $1,000 / 4.0% / $
Disney $25 / 2.0% / $
Disney $100 / 2.0% / $
Disney $1,000 / 2.0% / $
Fairmont Hotel $100 / 12.0% / $
Hyatt Hotels $25 / 9.0% / $
Hyatt Hotels $100 / 9.0% / $
Other Stuff
Product / % / Qty / Total
American Express $25 / 1.25% / $
American Express $100 / 1.25% / $
American Express $200 / 1.25% / $
Discover Card $50 / 1.25% / $
Discover Card $250 / 1.25% / $
Visa Five Back Card $50 / 1.25% / $
Visa Five Back Card $100 / 1.25% / $
Visa Five Back Card $250 / 1.25% / $
10 Gift Card Wrapper $2.00
(Holiday in Nov and Dec) / 10.0% / $

Total Due in All Columns $_____