Date: HOPE LUTHERAN SCHOOL Name: Pre-Order Scrip Form

Home Phone: Logged revised 11/29/2016  Pick up in office Sent  Send home with ______Grade_____ (by requesting this option, I agree to hold the school harmless when sending with my child)

Product % QTY Total GROCERY DEPARTMENT STORES Albertsons $25 / $100 4% $ JCPenney $25 / $100 5% $ Metropolitan Market $25 / $100 5% $ Kohl's $25 / $100 4% $ PCC $50 (Reloadable) 5% $ Macy's $25 / $100 10% $ QFC / Fred Meyer $25 / $50 / $100 5% $ Sears $25 / $100 / $250 4% $ Safeway $25 / $100 4% $ DISCOUNT STORES Thriftway (Morgan Jct.) $50 / $100 5% $ Burlington Coat Factory $25 8% $ Whole Foods Market $25 / $100 3% $ Kmart $25 / $50 4% $ APPAREL & ACCESSORIES Target $25 / $50 / $100 2.5% $ Aeropostale $25 7% $ Walmart / Sam's Club $25 / $100 2.5% $ Athleta $25 / $100 14% $ SPECIALTY RETAILERS Claire's $10 9% $ AMC Theaters/Loews Cineplex $25 8% $ Children's Place $25 12% $ American Girl $25 9% $ Crazy 8 $25 13% $ Barnes & Noble $10 / $25 9% $ Dennis Uniform $20 5% $ Bath & Body Works $10 / $25 13% $ Dressbarn $25 8% $ Build-A-Bear Workshop $25 8% $ Eddie Bauer $25 10% $ Family Christian Stores $25 9% $ Famous Footwear $25 8% $ GNC $25 8% $ Foot Locker $25 9% $ Guitar Center $25 4% $ Gap/ Banana Repl./Old Navy $25 / $100 14% $ Jo Ann Fabrics $25 6% $ Gymboree $25 13% $ Michaels Crafts $25 4% $ J. Crew $25 13% $ Oriental Trading Company $25 9% $ L.L.Bean $25 16% $ PetSmart $25 4% $ Lands' End $25 / $100 16% $ Rite Aid $25 4% $ Limited $25 9% $ Sally Beauty Supply $25 12% $ Motherhood Maternity $25 8% $ See's Candies $25 9% $ Payless Shoes $20 13% $ Sephora $20 5% $ Ross Dress for Less $25 8% $ The Container Store $25 / $100 9% $ Talbots $25 13% $ Toys R Us / Babies R Us $20 / $100 3% $ TJ Maxx / Marshalls $25 7% $ Walgreens $25 6% $ HAIR CARE Great Clips $25 8% $ Hair Masters $25 8% $ TOTAL $ Supercuts $25 8% $ Please make checks payable to HOPE Lutheran PTH DINING GAS & AUTO Applebee's $25 8% $ ARCO $50 1.5% $ Arby's $10 8% $ Chevron $50 1.5% $ Baja Fresh $25 7% $ Exxon/Mobil $50 1.5% $ Buca di Beppo $25 8% $ Jiffy Lube $30 8% $ Burger King $10 4% $ Shell $50 2.5% $ California Pizza Kitchen $25 8% $ HOME DÉCOR Cheesecake Factory $25 5% $ Bed Bath & Beyond $25 / $100 7% $ Chili's $25 11% $ Crate & Barrel $25 / $100 8% $ Chipotle Mexican Grill $10 10% $ Pier 1 $25 9% $ Claim Jumper $25 9% $ Pottery Barn / Williams-Sonoma $25 8% $ Coffee Bean & Tea Leaf $25 9% $ Restoration Hardware $25 / $100 12% $ Cold Stone Creamery $10 8% $ HOME IMPROVEMENT Dairy Queen $10 3% $ Ace Hardware $25 / $100 4% $ Domino's Pizza $10 8% $ Home Depot $25 / $100 4% $ Great Harvest Bread $10 6% $ Lowe's $25 / $100 4% $ Husky Deli $5 5% $ ONLINE & MAIL ORDER IHOP $25 8% $ .com $25 / $100 / $10 3% $ Jack in the Box $10 4% $ iTunes $15 / $25 5% $ KFC $5 8% $ Overstock.com $25 8% $ Old Country Buffet $25 5% $ Shutterfly $25 9% $ Outback $25 8% $ Zappos.com $25 / $100 8% $ P.F. Chang's $25 8% $ SPORTING GOODS Panera Bread $10 / $25 9% $ Bass Pro Shops $25 9% $ Papa John's Pizza $10 8% $ Big 5 Sporting Goods $25 8% $ Papa Murphy's Pizza $10 8% $ Cabela's $25 / $100 11% $ Pizza Hut $10 8% $ REI $25 8% $ Qdoba $25 7% $ Sports Authority $25 / $100 8% $ Rainforest Cafe $25 9% $ TRAVEL Red Lobster / Olive Garden $25 9% $ Avis Car Rental $50 8% $ Red Robin $25 9% $ Best Western $25 / $100 12% $ Ruth's Chris Steak $50 10% $ Budget Car Rental $50 8% $ $10 / $25 7% $ Carnival Cruise Lines $100 8% $ Subway $10 3% $ Choice Hotels $50 / $100 4% $ Taco Bell $10 5% $ Comfort Inn $50 / $100 4% $ Wendy's $10 4% $ Disney $25 / $100 2% $ ELECTRONICS & OFFICE Fairmont Hotels $100 9% $ Best Buy $25 / $100 3% $ Hard Rock Café $25 10% $ GameStop $25 3% $ Hyatt Hotels $50 / $100 10% $ Office Depot $25 4% $ Royal Caribbean $100 9% $ Office Max $25 5% $ Staples $25 / $100 5% $ See more options at www.shopwithscrip.com .