St. John’s School Scrip Order Form

NAME: PHONE: EXAMPLE ONLY STORE % $ QTY TOTAL$ Instructions:1.) Write the number of each denomination of 3.) Place order form and check in an unsealed *Example Store (W) 3 10 5 50 Scrip you desire, then the total dollar value. business size envelope, with your NAME and PHONE #. (W)Wahp. or (B)Breck. - local bus. only 2.) Make checks payable to St. John’s School Scrip. 4.) Drop off at either the Church Office or School. *Accepts payment on account RESTAURANTS % $ QTY TOTAL$ OTHER % $ QTY TOTAL$ RETAIL STORES % $ QTYTOTAL$ Applebees 8 25 Cenex 3 25 Home Depot 6 25 Arby's 10 10 City Brew Hall 10 25 iTunes 5 15/25 Buffalo Wild Wings 8 25 Delta Air Lines 4 250 JC Penney 5 25 Burger King 4 10 Econo Foods & Econo Spirits 5 25•100 K-Mart/Su pe r K-Mart 2 25 Chili’s 11 25 Jiffy Lube 8 30 *Kohl's 4 25 Chipotle Mexican Grill 10 10/25 Norwex 10 25-50 L.L. Bean 15 25/100 Cold Stone Creamery 8 10 Simonsons (W) 3 25 Land's End 16 25 Dairy Queen 3 10 The Boiler Room 10 20 Limited 9 25 Dakota Coffee 10 10 RETAIL STORES % $ QTY TOTAL$ Lowe's 4 25 Denny’s 7 10 Aéropostale 7 25 Macy's 10 25 Fry'n Pan 10 25 American Eagle Outfitters 10 25 Maurice's 7 20 Hill’s 210 Cafe (W) 10 10 Amazon.com 4 25 Menard’s 3 25 McDonald’s (W) 5 5 Banana Rep/Gap/Old Navy 9 25 Mrs. Field's 10 5 Old Chicago 9 25 Barnes & Noble/B. Dalton 9 10 Office Max 5 25 Olive Garden 9 25 Bath & Body Works 13 10 Old Navy 14 25 Panera Bread 8 25 Bed, Bath and Beyond 7 25 Olson Jewelers (W) 5 10/20 Papa Murphy's 8 10 Best Buy 2 25 Payless Shoe Source 13 20 Pizza Hut 8 10 Cabela's 11 25 Pier 1 Imports 9 25 Pizza Ranch 8 25 Claire's Boutique 9 10 Scheels 25 Prante’s 2 10/20 Dick's Sporting Goods 8 25 Sears 4 25 Red Lobster 9 25 Dressbarn 8 25 Target 2 25•100 Ruby Tuesday’s 8 25 Dunham’s Sports 8 25 TJ Max/Marshalls 7 25 Starbucks 9 10/25 Econo Lodge 3 25•100 *Wahpeton Drug/Gift (W) 5 20 Subway 3 10/25 Express 13 25 *Wahpeton Ace (W) 7 10 TGI Friday’s 9 25 Family Christian Stores 9 25 Hardware 20 Taco Bell 5 10 Fleet Farm 25 Wal-Mart 2 25/100 Texas Roadhouse 8 25 Gander Mountain 8 25 Zappo's 8 25/100 Wahpeton Deli (W) 10 10 Gordman's 7 25 TOTAL ORDER AMOUNT $ Wendy’s 9 10 Hairetage Hallmark 10 20 Try http://[email protected] The Wilkin B) 5 10/25 Home Goods 7 25 for additional retailers.

Orders due Friday of each week