Grocery Gift Card Order Form

Order Grocery Store Gift Cards

Please fill out this form and click submit on the bottom. If you choose to pickup your Grocery Store Gift Cards from the B'nai Shalom of Olney office, they will be ready within 24 hours. If you have chosen to have them delivered, you will be contacted by a synagogue volunteer to arrange for a convenient delivery time. If you have any questions contact the synagogue office at 301-774-0879 or by email scrip@bnaishalomofolney.org

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Your Name

(required)

Your Email Address

(required)

Your Street Address

(required)

Your City

Your Phone Number

(required)

Choose Grocery Store

Specify the denomination and quantity of Gift Cards

Denomination	Quanity
$25 Gift Card(s)
$50 Gift Card(s)
$100 Gift Card(s)

How would you like to receive your Gift Cards?

	I will pickup my order at BSO
	I would like the order delivered to my home (within 10 mile radius of BSO)

How will you pay?

	I will pay by check at pickup/delivery time.
	I would like you to charge my credit card on file at BSO (I'll call in the number if I have not already)

I understand I'm under no obligation, but I'd be happy to pay the 2.5% credit card charge incurred by BSO.

Yes, I will pay the 2.5% credit card administrative fee.

I would like to automatically refill this order on a monthly basis.

	Yes, I will automatically refill my order.
	No, this is a one time order.

Thanks for your support!