***Warning-- We strongly recommend that parents place and pickup scrip purchases from the school office. Since scrip is the equalivent of cash, we are concerned that your children are exposed to an unnecessary security risk to themselves and to the loss of the certificates.***

SCRIP SPECIAL ORDER FORM Name: ______Phone #: ______2/2/2012 If ordering through MMR school, please provide Child's Name: ______Classroom: ______SUPERMARKETS QTY TOTAL (No Vouchers)  Sam's Club $25 X =

RESTAURANTS Market $10 X = $10 X = Chart House $25 X = Cheesecake Factory $25 X = Chipotle $10 X = Chuck E Cheese $10 X = $10 X = Cracker Barrel $10 X = Dave & Busters $25 X = Domino's $10 X = Hard Rock Café $25 X = KFC $5 X = Long John Silver $5 X = Longhorn Steakhouse $25 X = Old Country Buffet $25 X = Papa John's $10 X = $10 X = Pizzaria Uno $25 X = $25 X = Ruby Tuesday $25 X = Ruth's Chris Steak House $50 X = $10 X = Roadhouse $25 X = TGI Friday $25 X = Wendy $10 X =

APPAREL & ACCESSORIES American Eagle Outfitters $25 X = Banana Republic $25 X = Bed Bath & Beyond $25 X = Bloomingdales $25 X = Bon Ton $25 X = Boscov $25 X = Brooks Brothers $25 X = Claire's /Afterthoughts/Icing $10 X = Express $25 X = Foot Locker/Champs $25 X = Gap $25 X = Gymboree $25 X = J Crew $25 X = J. Jill $25 X = LL Bean $25 X = Land's End $25 X = Lord & Taylor $25 X = Men's Warehouse $25 X = Motherhood Maternity $25 X = Old Navy $25 X = Payless Shoes $20 X = Ross $25 X = Sears $25 X = Talbots $25 X = The Children's Place $25 X =

HOME IMPROVEMENT Ace Hardware $25 X = $100 X = Lowe's $100 X = $500 X = Home Depot $100 X = $500 X =

SUBTOTAL = (over) Page 2

HOME DÉCOR Bed Bath & Beyond $25 X = Crate and Barrel $25 X = Pier 1 Imports $25 X = Pottery Barn $25 X = Restoration Hardware $25 X = White Barn Candle Co. $10 X = $25 X = Williams -Sonoma $25 X =

OFFICE & ELECTRONICS Office Max $25 X = Staples $25 X = Office Depot $25 X = Radio Shack $25 X = (No Vouchers)  Best Buy $25 X =

MOVIES & BOOKS AMC single tix $9.50 $9.50 X = AMC Theatres $25 X = Regal single tix $9.50 $9.50 X = Regal Entertainment $25 X = B. Dalton Booksellers $10 X = B. Dalton Booksellers $25 X =

HEALTH & BEAUTY Rite Aid $25 X = CVS $25 X = GNC $25 X = Great Clips $25 X = Regis salons $25 X = Sally Beauty $25 X = Walgreens $25 X = Ulta Salon $25 X =

GAS, AUTO & TRAVEL Advance Auto Parts $25 X = Avis Car Rental $50 X = Budget Car Rental $50 X = Jiffy Lube $30 X = Marriott $50 X = Pep Boys $20 X = (No Vouchers)  Wawa $100 X =

OTHER RETAIL Amazon.com $25 X = Cabela's $25 X = GameStop/EB Games $25 X = Honey Baked Ham $10 X = Jo-Ann fabrics $20 X = K-Mart $25 X = Michaels $25 X = Omaha Steaks $25 X = Sports Authority $25 X = OTHER: Check out the website (www.glscrip.com) for additional $____ X = stores and updates. All gift cards $____ available on Great Lake Scrip.com X = can be ordered here. $____ X = $____ X =

$____ X =

Please prepay with cash or check payable to MMR for the total amount of your order. TOTAL ORDER =

Church orders placed in the narthex before and after masses will be available the following weekend before and after all masses. School & Parish office orders-- Orders placed before 9:00am Monday can be picked up Friday of the same week. School & Parish office orders can also be picked up before or after all masses.