CHRIST THE KING SCHOOL

SCRIP ORDER FORM

Make Checks Payable To: Christ the King Scrip

STEP 1 — Provide Contact Information Name Phone Number(s) Order Date

Child’s Name/Grade School Family Name to be Credited

Email Address Total Amount $______□ Check # ______□ Cash STEP 2 — Choose your SCRIP from the chart below, calculate your total purchase, and complete the box above.

STEP 3 — Sign and submit your order with payment (cash or check made payable to “CK Scrip”). I hereby give permission to release my SCRIP to the child listed above. I understand that it will come in the following week’s Tuesday folder. I will not hold Christ the King School liable for lost or stolen SCRIP. OR □ Please hold in the school office for me to pick up. Signature______

BEST SELLERS % Qty Total Variety/Dept. Qty % Total ^ $ Stores Restaurants % Qty Total 3% JC Penney #^ California Pizza Kitchen $25/$100 5% $ 4% $ $25 / $100 $10 Chevron # $ Kohl’s ^ Chipotle ^ 1% 4% 10% $ $50/$100/$250 $25 / $100 $10 QFC/Fred Meyer $ Marshalls/T.J. Maxx ^ Chuck E. Cheese 5% 7% $ 8% $ $25*/$100* $25 / $100 $10 Ross Dress for Less Claim Jumper ^ Safeway # $ 8% $ 9% $ 4% $25 $25 / $100 $25*/$100* Sears ^ Denny’s 4% $ 7% $ Shell # $ $25 / $100 / $250 $10 2.5% Target # Domino’s Pizza #^ 2.5% $ 8% $ $25/$50/$100 $25 / $100 $10 #^ $ Apparel/Accessories Great Harvest 7% % Total 6% $ $10*/$25* Qty $10 Banana Republic #^ IHOP ^ Target # $ 14% $ 8% $ 2.5% $25 / $100 $25 $25*/$100* Claire’s Jack in the Box 9% $ 4% $ Sam’s $ $10 $10 Crazy 8 # KFC Club/Walmart ^ 13% $ 8% $ 2.5% $5 $25*/$100*/$250 $25 Educational Outfitters Olive Garden ^ 5% $ 9% $ $20 $25 Grocery & Drugs % Qty Total Eddie Bauer P.F. Chang ^ 10% $ 8% $ Albertsons # $25 $25 4% $ Gap #^ Panera Bread ^ $25 / $100 14% $ 9% $ QFC/Fred Meyer $25 / $100 $10 / $25 5% $ Gymboree # Pizza Hut $25 / $100 13% $ 8% $ Safeway # $25 $10 4% $ J. Crew Qdoba Mexican Grill $25 / $100 13% $ 7% $ Sam’s Club/Wal-Mart ^ $25 $25 2.5% $ Lands’ End ^ Quiznos $25 / $100 / $250 16% $ 10% $ Walgreens $25 / $100 $10 6% $ L.L. Bean ^ Red Robin ^ $25 / $100 16% $ 9% $ Whole Foods Market $25 / $100 $25 Macy’s ^ Subway # #^ 3% $ 10% $ 3% $ $25 / $100 $25 / $100 $10/$50 Old Navy #^ Gas & Auto % Qty Total 14% $ $25 / $100 Arco # $50 / $100 1.5% $ Entertainment % Qty Total $250 2.5% AMC/Cineplex Chevron # Odeon/Loews Theatres Symbol Key: $ $ $50 / $100 / $250 1% $25 #^ 8% * Typically in stock Jiffy Lube #^ $9.50 single admit 10% 8% $ # Available for Reload $30 Regal Ent. Group ^ Available for SCRIPNow purchase Shell # $25 ^ 8% $ 2.5% $ $25 / $50 / $100 $9.50 single admit ^ 10% 76 # 1.5% $ $25 / $100 Some Scrip may be in stock and available for immediate purchase; please email SCRIP Coordinators at [email protected].

Coffee & Drinks % Qty Total

Jamba Juice 7% $ Travel % Qty Total $10 Avis Car Rental Starbucks #^ Specialty Retailers % Qty Total 8% $ 7% $ $50 $10 / $25 Amazon.com ^ 3% $ BedandBreakfast.com $25 / $100 10% $ Electronics & $50 % Qty Total American Express Card Office Supplies 1.25% $ Best Western Intern’al $50 / $100 / $200 12% $ Best Buy ^ $25 / $100 3% $ American Girl $25 / $100 / $250 9% $ Budget Car Rental $25 / $100 8% $ Game Stop ^ $50 3% $ Babies-R-Us $25 1.5% $ Carnival Cruise Lines $20 8% $ Office Depot $100 4% $ Barnes & Noble ^ $25 / $100 9% $ Comfort Inn & Suites # $10 / $25 / $100 3% $ Office Max $50 / $100 5% $ Bath & Body Works #^ $25 / $100 13% $ Courtyard by Marriott ^ $10 / $25 8% $ Radio Shack $50 / $100 / $500 4% $ Bed, Bath & Beyond $25 7% $ Fairfield Inn & Suites by $25 / $100 Staples ^ Marriott ^ 8% $ 5% $ Build-A-Bear Workshop $25 / $100 8% $ $50 / $100 / $500 $25 ^ Fairmont Hotels Sporting Goods % Qty Total Crate and Barrel ^ 9% $ 8% $ $100 $25 / $100 REI Sporting Goods Hyatt Hotels #^ 8% $ iTunes ^ 9% $ $25 5% $ $50 / $100 $15 / $25 Sports Authority #^ Marriott Hotels ^ 8% $ Jo-Ann Fabrics 8% $ $25 / $100 6% $ $50 / $100 / $500 $25 Hardware & Home Qty Quality Inn# PetSmart 4% $ % Total 4% $ $50 / $100 Improvement $25 Residence Inn— Home Depot ^ Pottery Barn ^ 8% $ Marriott ^ 8% $ $25 / $100 / $500 / 4% $ $25 / $100 $1000 $50 / $100 / $500 See’s Candies Lowe’s #^ $17.50 (1 lb.) 20% $ $20 / $25 / $100 / 4% $ $25 9% $500 / $1,000 Shutterfly ^ $ 9% $25 Toys-R-Us 3% $ $20

Symbol Key: * Typically in stock # Available for Reload ^ Available for SCRIPNow purchase

Additional Retailers Listed at www.glscrip.com Write in any other Scrip Cards you would like added to your order on the lines below.

Retailer Name Amount of Card % Qty. Total

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Make Checks Payable To: Christ the King Scrip or CK Scrip

Orders are due each Wednesday no later than 9:00 a.m. for delivery the following week.

UPDATED 1/2014