eScrip for Northern Californians

The following Northern California markets have eScrip Community Cards. Every time you shop at one of these markets, your grocer will make a donation of up to 5% of your purchase amount to the Polly Klaas Foundation. All you need to do is print out this page, fill in the form, and take it to the manager of one of the groceries listed here. They will give you a Community Card, then you can feel good about making your own grocery purchases, and providing donations to the Polly Klaas Foundation, which will be used to help find missing children, and help keep kids safe.

Here is the list of participating markets:

eScrip Community Card Registration

Use this card every time you shop, and earn up to 5% of your purchase amount for the Polly Klaas Foundation.

Earning Donations for:  Polly Klaas Foundation

Please print clearly:

Name:____________________________________________________________________

Email:**___________________________________________________________________

Mailing Address:____________________________________________________________

City:______________________________________________________________________

State: ____________________________ Zip:___________________________

Cell/Phone Number, with Area Code:**

___________________________________________

**By providing your email address, you will receive updates and special offers from the market.

**Your phone number will be linked to your account. When you check out, you can provide the cashier with either your card or your phone number, and your purchase amount will be credited for the market's donation amount.

Please print out this form, fill it out, and take it to your participating market.