ST MARY SCRIP ORDER FORM 1812 Lynn Ave., Altoona, WI 54720 Phone: (715) 855-1294 All business names in bold can be used throughout the USA, non bold businesses are local only. St. Mary is not responsible for lost or stolen certificates . Date Name Phone # SEE BACK OF FORM FOR MORE SCRIP
Merchant Name Scrip # of Total Merchant Name Scrip # of Total $ amt. each $ amt. $ amt. each $ amt. Altoona Family Restaurant (10%) 10 Kwik Trip (5%) 25 25 50 Amazon.com (2.25%) 25 100 100 Menards (3%) 25 Applebee's (8%) 25 100 Arby's (10%) 10 Michaels (4%) 25 Cancun's (10%) 10 Noodles & Co. (8%) 10 20 Olive Garden (8%) 25 Caribou Coffee (6%) 10 Panera Bread (8%) 10 Chipotle (10%) 10 25 Culver's (5%) 5 Papa Murphys (8%) 10 10 Perkins (10%) 25 Dairy Queen (3%) 10 Red Lobster (8%) 25 Dunkin Donuts (3%) 10 Rumps (10%) 50 Farm & Fleet (5%) 25 Scheels (5%) 25 100 Scheels (5%) 50 Festival Foods (3%) 50 Sport Clips (15%) 20 100 Starbucks (7%) 10 Fleet Farm (3.5%) 25 25 Great Clips (8%) 25 Subway (6%) 10 Great Harvest Bread (6%) 10 Taco Bell (5%) 10 Grizzly's (10%) 25 Taco John's (10%) 10 Hardee's (10%) 10 Target (2.5%) 25 Holiday Stores (10%) 25 100 50 Texas Roadhouse (8%) 25 100 T J Maxx (7%) 25 iTunes (12.5%) 100 Walgreens (5%) 25 Kohl's (5%) 10 Walmart (2.5%) 25 25 100 50 Woodman's (5%) 50 100 100 Order total $______Make checks payable to: St Mary Scrip Checks written to St. Mary Scrip are not tax deductible. Tuition Credit for (name) ______To be applied RCSFaith FamilyFormation Fee Fee (check one) Church ______School PAYMENT MUST ACCOMPANY ORDER Scrip Team Use Only Total Amount Paid: Cash ______Check No. ______Sold by: ______
6/17/2020 SPECIAL ORDER SCRIP CARDS
Name: These cards will be ordered twice a month. Please allow 2-3 weeks for delivery Make check payable to "St. Mary Scrip" Payment must accompany order.
Merchant Name Scrip # of Total Merchant Name Scrip # of Total $ amt. each $ amt. $ amt. each $ amt.
Action City (20%) 25 Fazoli's 25
Azul's (10%) 10 Great Clips (8%) 25
Bath & Body (12%) 10 JC Penney (5%) 25
Bath & Body (12%) 25 Jo-Ann Fabric (6%) 25
Best Buy (4%) 25 OfficeMax/Depot (5%) 25
Best Buy (4%) 100 Old Navy/Gap (14%) 25
BP Oil (1.5%) 100 Pizza Hut (8%) 10
Buffalo Wild Wings (8%) 25 Red Robin (8%) 25
Burger King (4%) 10 Scheels (5%) 10
Burrachos (10%) 10 Scheels (5%) 100
Claires (9%) 10 Taco Bell 10
Cold Stone Creamery (11%) 10 Taco John's (10%) 10
CVS (6%) 25 Ulta (4%) 25
Domino's (8%) 10 Walgreens (5%) 100
Famous Dave's (5%) 10 Wendy's (4%) 10
Order total $______
6/17/2020