Family Order Form Created: 10/23/2019 9:11:40 AM Wayne Trace Performing Arts Association/OH Order by Nov. 14 and pick up Nov.19 Order by Dec. 5 and pick up Dec. 10 Order Dec. 12 and pick up Dec. 17 There are many more stores to choose from...please go to www.shopwithscrip.com and click on "retailers" for a full listing. Name Customer #

Check # Order Date

Product % QTY Total Product % QTY Total Product % QTY Total Ace Hardware $100.00 3.74% $ Bath & Body Works 11.74% $ Chili's Grill & Bar $25.00 10.74% $ $10.00 Ace Hardware $25.00 3.74% $ Chili's Grill & Bar $50.00 10.74% $ Bath & Body Works 11.74% $ Advance Auto Parts 6.74% $ $25.00 9.74% $ $25.00 Bed Bath & Beyond 6.74% $ $10.00 aerie $25.00 9.74% $ $25.00 Chipotle Mexican Grill 9.74% $ Best Buy $100.00 3.74% $ $25.00 Aeropostale $25.00 9.74% $ Chuck E. Cheese's 7.74% $ Best Buy $25.00 3.74% $ Amazon.com $10.00 1.99% $ $10.00 Best Buy $250.00 3.74% $ Circle K $25.00 1.24% $ Amazon.com $100.00 1.99% $ Blaze Pizza $25.00 9.74% $ Claire's $10.00 8.74% $ Amazon.com $25.00 1.99% $ Blimpie $10.00 10.74% $ 10.74% $ AMC Theatres $25.00 7.74% $ $10.00 Blimpie $5.00 10.74% $ AMC Theatres $50.00 7.74% $ Cold Stone Creamery 10.74% $ Bob Evans 9.74% $ $5.00 AMC Theatres Single 9.74% $ Restaurants® $10.00 Cracker Barrel $10.00 7.74% $ Ticket $10.00 Bob Evans 9.74% $ AMC Theatres Single 9.74% $ Restaurants® $25.00 Cracker Barrel $25.00 7.74% $ Ticket $12.00 Bonefish Grill $25.00 7.74% $ Crate and Barrel $25.00 7.74% $ American Eagle® 9.74% $ $25.00 BP $100.00 1.24% $ CVS Pharmacy $10.00 5.74% $ American Girl $100.00 8.74% $ BP $250.00 1.24% $ CVS Pharmacy $100.00 5.74% $ American Girl $25.00 8.74% $ BP $50.00 1.24% $ CVS Pharmacy $25.00 5.74% $ App Store & iTunes 4.74% $ $15.00 Bubba Gump Shrimp 8.74% $ $10.00 2.74% $ Co. $25.00 App Store & iTunes 4.74% $ Darden Restaurants 7.74% $ $25.00 Buca di Beppo $25.00 7.74% $ $10.00 Apple App Store & 4.74% $ Buckle $25.00 7.74% $ Darden Restaurants 7.74% $ iTunes $15.00 $100.00 Budget Car Rental 7.74% $ Apple App Store & 4.74% $ $50.00 Darden Restaurants 7.74% $ iTunes $25.00 $25.00 Buffalo Wild Wings® 7.74% $ Apple iTunes $15.00 4.74% $ $10.00 Dave & Buster's $25.00 12.74% $ Apple iTunes $25.00 4.74% $ Buffalo Wild Wings® 7.74% $ Denny's $10.00 6.74% $ $25.00 Applebee's $10.00 7.74% $ Dick's Sporting Goods 7.74% $ Build-A-Bear Workshop 7.74% $ $100.00 Applebee's $25.00 7.74% $ $25.00 Dick's Sporting Goods 7.74% $ $10.00 3.74% $ Applebee's $50.00 7.74% $ $25.00 Burlington $25.00 7.74% $ Disney $100.00 2.74% $ Arby's $10.00 7.74% $ buybuyBABY $25.00 6.74% $ Disney $1000.00 2.74% $ AutoZone $25.00 7.74% $ Cabela's $100.00 9.74% $ Disney $25.00 2.74% $ B.O.B. $25.00 4.74% $ Cabela's $25.00 9.74% $ Domino's $10.00 7.74% $ Banana Republic 13.74% $ $25.00 Carrabba's Italian Grill 7.74% $ Domino's $25.00 7.74% $ Barnes & Noble $10.00 7.74% $ $25.00 DSW (Designer Shoe 7.74% $ Cheddars $10.00 7.74% $ Barnes & Noble $25.00 7.74% $ Warehouse) $100.00 Cheddars $25.00 7.74% $ DSW (Designer Shoe 7.74% $ Barnes & Noble $5.00 7.74% $ Warehouse) $25.00 Cheesecake Factory 4.74% $ Bass Pro Shops 9.74% $ $25.00 Dunham's Sports 7.74% $ $100.00 $25.00 Children's Place $25.00 11.74% $ Bass Pro Shops $25.00 9.74% $ Dunkin' Donuts $10.00 2.74% $

Make Checks Payable To: Wayne Trace Performing Arts Total Due All Columns: $ Family Order Form Created: 10/23/2019 9:11:40 AM Wayne Trace Performing Arts Association/OH Order by Nov. 14 and pick up Nov.19 Order by Dec. 5 and pick up Dec. 10 Order Dec. 12 and pick up Dec. 17 There are many more stores to choose from...please go to www.shopwithscrip.com and click on "retailers" for a full listing. Name Customer #

Check # Order Date

Product % QTY Total Product % QTY Total Product % QTY Total Dunkin' Donuts $25.00 2.74% $ Kmart $25.00 3.74% $ Menards $100.00 2.74% $

EB Games $25.00 2.74% $ Kmart $50.00 3.74% $ Menards $25.00 2.74% $

Einstein Bros. Bagels 9.74% $ Kohl's $100.00 3.74% $ Michaels $25.00 3.74% $ $10.00 Kohl's $25.00 3.74% $ Nike $25.00 11.74% $ Family Video $10.00 11.74% $ ® 7.74% $ Noodles & Company 7.74% $ Famous Footwear 7.74% $ Doughnut Corporation $10.00 $25.00 $10.00 O'Charley's $25.00 12.74% $ Fazoli's $25.00 8.74% $ L.L.Bean $100.00 15.74% $ Office Depot / Office 4.74% $ Finish Line $25.00 9.74% $ L.L.Bean $25.00 15.74% $ Max $25.00

Foot Locker $25.00 7.74% $ Lands' End $100.00 14.74% $ Old Navy $25.00 13.74% $

GameStop $25.00 2.74% $ Lands' End $25.00 14.74% $ Olive Garden $10.00 7.74% $

Gap $25.00 13.74% $ Lane Bryant $25.00 7.74% $ Olive Garden $25.00 7.74% $

Geek Squad & Best Buy 3.74% $ Pizza 7.74% $ OshKosh $25.00 9.74% $ $100.00 $20.00 7.74% $ Geek Squad & Best Buy 3.74% $ Logan's Roadhouse 9.74% $ $10.00 $25.00 $25.00 Outback Steakhouse 7.74% $ Geek Squad & Best Buy 3.74% $ Long John Silver's 7.74% $ $25.00 $250.00 $10.00 Outback Steakhouse 7.74% $ Gordon Food Service 3.74% $ LongHorn Steakhouse 7.74% $ $50.00 Store $100.00 $10.00 P.F. Chang's China 7.74% $ Gordon Food Service 3.74% $ LongHorn Steakhouse 7.74% $ Bistro $25.00 Store $25.00 $25.00 $10.00 7.74% $ Great Clips $25.00 7.74% $ Lowe's $100.00 3.74% $ Panera Bread $25.00 7.74% $ Groupon.com $25.00 6.74% $ Lowe's $1000.00 3.74% $ Panera Bread $5.00 7.74% $ Guitar Center $25.00 3.74% $ Lowe's $20.00 3.74% $ Panera Bread $50.00 7.74% $ Hardee's $10.00 4.74% $ Lowe's $25.00 3.74% $ Papa John's Pizza 8.74% $ Home Depot $10.00 3.74% $ Lowe's $500.00 3.74% $ $10.00

Home Depot $25.00 3.74% $ Macy's $25.00 9.74% $ Papa Murphy's Pizza 7.74% $ $10.00 HomeGoods $25.00 6.74% $ Marathon $100.00 2.74% $ Peebles $25.00 7.74% $ IHOP $10.00 7.74% $ Marathon $25.00 2.74% $ PetSmart $25.00 4.74% $ IHOP $25.00 7.74% $ Marathon $250.00 2.74% $ Pier 1 Imports $25.00 8.74% $ iTunes $15.00 4.74% $ Marshalls $100.00 6.74% $ (Not AK or HI) 7.74% $ $10.00 iTunes $25.00 4.74% $ Marshalls $25.00 6.74% $ Pottery Barn $25.00 7.74% $ J. Crew $25.00 12.74% $ Maurices $20.00 6.74% $ Mexican Grill 6.74% $ JCPenney $100.00 4.74% $ Meijer (not AK and HI) 2.74% $ $25.00 $10.00 JCPenney $25.00 4.74% $ $10.00 7.74% $ Meijer (not AK and HI) 2.74% $ Jiffy Lube $30.00 7.74% $ $100.00 Red Lobster $25.00 7.74% $

Jo-Ann Fabric and Craft 5.74% $ Meijer (not AK and HI) 2.74% $ $25.00 7.74% $ Stores $25.00 $25.00 Regal $25.00 7.74% $ Jos. A. Bank $25.00 9.74% $ Meijer (not AK and HI) 2.74% $ $50.00 Rite Aid $25.00 3.74% $ Kids Foot Locker $25.00 7.74% $ Men's Wearhouse 7.74% $ $25.00 Ruby Tuesday $25.00 7.74% $

Make Checks Payable To: Wayne Trace Performing Arts Total Due All Columns: $ Family Order Form Created: 10/23/2019 9:11:40 AM Wayne Trace Performing Arts Association/OH Order by Nov. 14 and pick up Nov.19 Order by Dec. 5 and pick up Dec. 10 Order Dec. 12 and pick up Dec. 17 There are many more stores to choose from...please go to www.shopwithscrip.com and click on "retailers" for a full listing. Name Customer #

Check # Order Date

Product % QTY Total Product % QTY Total Ruth's Chris Steak 9.74% $ Target $25.00 2.24% $ House $50.00 Target $50.00 2.24% $ Sam's Club $10.00 2.24% $ Texas Roadhouse 7.74% $ Sam's Club $100.00 2.24% $ $100.00 Sam's Club $25.00 2.24% $ Texas Roadhouse 7.74% $ $25.00 Sam's Club $250.00 2.24% $ TGI Fridays $25.00 8.74% $ Sam's Club $50.00 2.24% $ 3.74% $ Sears $100.00 3.74% $ $10.00 The Home Depot 3.74% $ Sears $25.00 3.74% $ $100.00 Sears $250.00 3.74% $ The Home Depot 3.74% $ $25.00 Shell $100.00 1.24% $ The Home Depot 3.74% $ $500.00 Shell $25.00 1.24% $ $10.00 4.74% $ Shell $50.00 1.24% $ Walgreens $100.00 4.74% $ Shoe Carnival $25.00 4.74% $ Walgreens $25.00 4.74% $ Shoe Dept. $25.00 7.74% $ Walmart $10.00 2.24% $ Shutterfly $25.00 8.74% $ Walmart $100.00 2.24% $ Speedway $100.00 3.74% $ Walmart $25.00 2.24% $ Speedway $25.00 3.74% $ Walmart $250.00 2.24% $ Staples $25.00 4.74% $ Walmart $50.00 2.24% $ $10.00 6.74% $ Wendy's $10.00 6.24% $ Starbucks $25.00 6.74% $ Williams Sonoma 7.74% $ Starbucks $5.00 6.74% $ $25.00

Starbucks $50.00 6.74% $ Zaxby's $25.00 7.74% $

Steak 'n Shake $10.00 7.74% $

Subway Restaurants 5.74% $ $10.00 Restaurants 5.74% $ $50.00 T.J. Maxx $100.00 6.74% $

T.J. Maxx $25.00 6.74% $

T.J. 6.74% $ Maxx/Marshalls/HomeG oods/Sierra Trading Post $25.00 $10.00 4.74% $

Taco Bell $25.00 4.74% $

Taco Bell $5.00 4.74% $

Talbots $25.00 12.74% $

Target $10.00 2.24% $

Target $100.00 2.24% $

Make Checks Payable To: Wayne Trace Performing Arts Total Due All Columns: $