SCRIP ORDER FORM - revised 8/14/2020 Side 1

Grocery (R, E) 8% $10 Landry’s/Rainforest Café 9% $25/100 Albertsons 4% $25/50/ Claim Jumper (R, E) /Safeway/Vons (R) 100 Smart & Final 3% $25/50 Little Caesar's 8% $20 100 Mimi’s Café 8% $25 Sprouts 5% $25/50/ Olive Garden (R, E) 8% $25/100 100 Stater Brothers (R, E) 5% $25/100 (E) 10% $25/50 Panera Bread (R, E) 8% $10/25/ 50 Applebees (E) 8% $25/50 Papa John's Pizza (R*, E) 8% $10 Arby’s 8% $10 PF Chang's (E) 8% $25/100 Baja Fresh 10% $25 (E) 8% $10 Black Angus 12% $25 Rainforest Cafe (R, E) 9% $25/100 Buca di Beppo (E) 8% $25 Red Lobster (R, E) 8% $25 Buffalo Wild Wings (R, E) 8% $10/25 Red Robin (E) 8% $25 (R*, E) 4% $10 Rubios Coastal Grill (E) 10% $25 8% $25 See’s Candy 20% $22.50 Carl’s Jr. 5% $10 9% $25 Cheesecake Factory 5% $25 (R, E) 7% $10/25/ 50 Chili’s (E) 11% $25/50 (R, E) 6% $10/50 Chipotle (E) 10% $10/25 (R) 5% $10/25 Chuck‐E‐Cheese (E) 8% $10 TGI Fridays (E) 9% $25 Coffee Bean & Tea Leaf 9% $25 Total Wine & More (E) 7% $25/100 (R,E) Coldstone Creamery (E) 11% $10 Wendy’s 6.5% $10 Del Taco 7% $10 Total from side 1 Denny's 7% $10 Domino’s Pizza (R, E) 8% $10/25 Total from side 2 El Pollo Loco 6% $10 Glory Days 10% $10 TOTAL ORDER HoneyBaked Ham 12% $25 Orders must be pre‐paid with this form. Islands 8% $25 Scrip is subject to change without notice. Jack in the Box 4% $10 Jamba Juice (E) 6% $10 E = eGift Cards, R = Reload, R* = Reload Overnight Make checks payable to: St. Cornelius School

___I give my student ______in grade ____ permission to bring scrip home from school.

___Please call for pick-up at the number provided below.

Signature ______Date ______

Phone ______

SCRIP ORDER FORM - Page 2 Department/Retail/Travel Kohl’s (E) 4% $25/100 Lands End (E) 15% $25/100 Ace Hardware 4% $25/100 Lowe’s (R, E) 4% $20/25/100/ Amazon.com (E) 2.25 $25/100 (No pymt on acct) 500/1,000 % Macy’s (E) (No pymt on 10% $25/100/500 AMC Theaters (E) 8% $25/50 acct) AMC Single Ticket 10% $10/12 Nordstrom (E) 6% $25/100 American Eagle (E) 10% $25 Overstock.com (E) 8% $25 American Girl 9% $25/100 Regal /Edwards/UA (E) 8% $25 Arco (R) 1.5% $50/100/250 Regal Single Ticket (E) 10% $10.50 Auto Zone 8% $25 Regis Salons 8% $25 Bass Pro Shop (E) 10% $25/100 Rite‐Aide 4% $25 Bath & Body Works (R,E) 12% $10/25 Ross 8% $25 Barnes & Noble (R, E) 8% $10/25/100 Saks Fifth Avenue 12% $50 Bed, Bath & Beyond (E) 7% $25/100 Sephora (E) 5% $25 Best Buy (E) 4% $25/100/250 Shell (R) 1.5% $25/50/100 Big 5 Sporting Goods 8% $25 Shutterfly (E) 9% $25 Best Western Int’l 12% $25/100 Southwest Airlines (E) 4% $250 Build‐A‐Bear Workshop 8% $25 Staples (E) 5% $25/100 (E) Target (R, E) 2.5% $10/25/50/ Burlington (E) 8% $25 100/ 250 Buy Buy Baby (E) 7% $25/100 Texaco/Chevron (CA 1% $50/100/250 Cabela's (E) 10% $25/100 only) (R) Carnival Cruise Lines (E) 8% $100/500 TJ Maxx/Marshall’s 7% $25/100 Homegoods (E) Carters (R) 10% $25 ULTA Beauty (E) 4% $25 Children’s Place (E) 12% $25 Visa Gift Card 1.25 $50/100/250 Claire’s 9% $10 % Cost Plus World Market 7% $25/100 Walgreens 5% $25/$100 (E) Walmart/Sam’s Club 2.5% $25/50/100/ Crate and Barrel (E) 8% $25/100 (R, E) 250/500 CVS Pharmacy (R, E) 6% $25/100 Williams‐Sonoma 8% $25/100 Disney (E) 3% $25/100/ Pottery Barn (E) 1,000 76 Gas (R) 1.5% $25/100 Express/Structure (E) 10% $25 Zappos.com (E) 8% $25/100 Exxon/Mobil (R) 1% $50/250 Footlocker/Kinney/ 8% $25 Other Retailers (From Website) Champs (E)

Gap/Old Navy/Banana Rep 14% $25/100 (R, E) Great Clips 8% $25 Total above Groupon (E) 7% $25 Add total to other side Hallmark Gold Crown 4% $25

(R,E) Scrip must be pre‐ordered and pre‐paid. Please Hilton 2% $100/500 include your payment. Scrip orders are due Friday Home Depot (R, E) 4% $25/100/500 by noon. (No pymt on acct) / 1,000 iTunes (E) 5% $15/25 Visit ShopWithScrip.com for additional J Crew 13% $25 participating retailers. Anything on the online list JC Penney (R, E) 5% $25/100 can be ordered.

Jo Ann Fabrics 6% $25 Name ______