St. Thomas Aquinas SCRIP ORDER FORM

Thank you! Your support is greatly appreciated! Please remember that we can sell only the amounts listed on the order form.

Name:______Phone:______Date:______

Check# :______Amount:______* Please make checks payable to: St. Thomas Aquinas *

Filled by______NEEDS:______

Retailer Profit Card Qty. Total Retailer Profit Card Qty. Total (c.o.a.) = certificate on account for Amount (c.o.a.) = certificate on for Amount school account school All Seasons Gutter/New $5.00 $100 Claire’s $0.90 $10 All Seasons Gutter/Topper $10.00 $100 Cold Stone $0.80 $10 Creamery American Eagle Outfitters $2.00 $25 Courtyard/Marriott $6.00 $50 Applebees $2.00 $25 Critter $0.50 $10 Nation(Dyvig’s) Arby’s $0.80 $10 Barnes & Noble/B. Dalton $1.00 $10 Derry Auto (c.o.a.) $1.00 $25 Barnes & Noble/B. Dalton $2.50 $25 Derry Auto (c.o.a.) $2.50 $50 Bath and Body Works $1.30 $10 Derry Auto (c.o.a.) $5.00 $100 Bath and Body Works $3.25 $25 Dillard’s $2.25 $25 Bed, Bath and Beyond $1.75 $25 Dress Barn $2.00 $25 Best Buy $0.50 $25 Express $2.50 $25 Best Buy $2.00 $100 Fareway $0.50 $25 Big Time Cinema (Fridley’s) $1.00 $10 Fareway $1.00 $50 Borders/Waldenbooks $0.90 $10 Fareway $2.00 $100 Borders/Waldenbooks $2.25 $25 Fairfield Inn/Marriott $6.00 $50 Build-A-Bear $2.00 $25 Fazoli’s $1.75 $25 Burger King $0.50 $10 Finish Line $2.50 $25 Cabela’s $3.25 $25 Flower Cart (c.o.a.) $1.25 $25 Carlos O’Kelly $0.90 $10 Foot Locker $2.25 $25 Casey’s $0.30 $10 Fuhs Pastry $1.00 $10 Casey’s $0.75 $25 Gap/Old $2.25 $25 Navy/Banana Republic Casey’s $1.50 $50 GameStop $0.75 $25 Cheesecake Factory $1.25 $25 Gerber’s (c.o.a.) $2.50 $50 Chili’s/Macaroni Grill/On the $2.75 $25 Gerber’s (c.o.a.) $5.00 $100 Boarder Chuck E. Cheese $0.80 $10 Gilbert Jewelry $2.50 $25 (c.o.a.) Chuong Garden $6.00 $30 Gilbert Jewelry $7.50 $75 (c.o.a.) GNC $2.00 $25 Scrip Order Form Continued Gymboree (Children’s $3.25 $25 Panera Bread $0.90 $10 Clothing) Hard Rock Cafe $2.50 $25 Pampered Chef $3.75 $25 (Mary Frankhauser) Heart-N-Home $1.00 $10 Payless Shoes $2.60 $20 Home Appliance $0.50 $25 Pier 1 Imports $2.25 $25 Home Appliance $2.00 $100 PF Chang China $1.75 $25 Bistro Home Depot $0.75 $25 Pizza Hut $0.90 $10 Home Depot $3.00 $100 Pottery $2.00 $25 Barn/Williams Sonoma Hyatt Hotels $2.25 $25 Romancing the $1.50 $15 Home Hy-Vee $0.20 $10 Sally Beauty Co. $3.00 $25 Hy-Vee $0.50 $25 Saloon Pizza – eat $2.10 $10.60 in/carry out lrge 2 topping only Hy-Vee $1.00 $50 Sears $1.75 $25 Hy-Vee $2.00 $100 Sears $7.00 $100 Iowa Meat Shop (Scott Rector) $10.00 $50 Sears $17.50 $250 Iowa Meat Shop (Scott Rector) $20.00 $100 Second St. $1.00 $10 Emporium J. Crew $3.25 $25 Second St. $2.00 $20 Emporium J.C. Penny $1.50 $25 Second St. $3.00 $30 Emporium J.C. Penny $6.00 $100 Shoe Carnival $1.25 $25 Jo-Ann Fabrics $1.20 $20 Shoppers Supply $1.25 $25 K Mart $1.00 $25 Shoppers Supply $2.50 $50 K Mart $2.00 $50 Shoppers Supply $25.00 $500 Kentucky Fried Chicken $0.45 $5 Shutterfly $3.50 $25 Kohl’s $1.00 $25 Sport s World $1.50 $15 Kohl’s $4.00 $100 Sports World $2.00 $20 Kum & Go $0.50 $10 Staples $2.00 $25 Kum & Go $1.25 $25 Starbucks $.070 $10 Kum & Go $2.50 $50 Subway $0.30 $10

Land’s End $3.00 $25 Ted’s Carwash 5 - $5.00 $35 $5.00 washes Laser Car Wash (5 at option $5.00 $35 T.J. Maxx/ Marshalls $1.75 $25 #2) Leon’s $1.00 $10 Toys-R-Us/Kids-R- $0.20 $20 Us/Babies-R-Us Limited (The Limited) $2.25 $25 VISA Prepaid card $0.50 $25 Long John Silver’s $0.45 $5 Visa Prepaid card $1.00 $50 Lowes (also avail. in $100 & $1.00 $25 Visa Prepaid card $2.00 $100 $500) Maurices $1.40 $20 Walgreens $0.40 $20 Menards $0.75 $25 Wal-Mart $0.50 $25 Menards $3.00 $100 Wal-Mart $2.00 $100 Office Max $1.25 $25 Wendy’s $0.90 $10 Olive Garden/Red Lobster $2.25 $25 Williams Drug $0.30 $10 Osweilers $2.00 $20 Younkers/Carson $2.00 $25 Pirie Outback Steakhouse $1.25 $25 Younkers/Carson $8.00 $100 Pirie Old Chicago/ Rock Bottom $1.50 $25 Questions: Call Erin Please look at our list of other Tasler cards! 832-4171