ESMS Scrip Order Form Please fill out the form and drop it off, together with your check or cash, at the School Office inside the Scrip Box, we will check the box daily. If we have it in stock we will fill the orders by the following day, if we do not have in stock, we will place an order from our supply company every Tuesday to make sure we get by Fridays. You can also order for all the companies listed on the PDF list at the School Web site (Parent Information), just write the name on the bottom or back of the form. This is a ALL YEAR AROUND Fundraising Program, if you have any special occasions during the summer, you can call Alex, Scrip Coordinator, information below. Thank you.

Company Name Our % Quantity Amount Company Name Our % Quantity Amount $10 Babies 'R Us / Toys 'R Us 1.5% $20 Barnes & Nobel/B Dalton 9% $25 7% $25 Baskin Robbins 9% $2 $25 Best Buy 3% Bath & Body Works 13% $25 $100 Bed, Bath & Beyond 7% $25 Buca Di Beppo 8% $25 Big 5 Sporting Goods 8% $25 Build-a-Bear Workshop 8% $25 12% $10 $25 Crate and Barrel 8% $25 $100 CVS Pharmacy 6% $100 Cheesecake Factory 5% $25 California Pizza Kitchen 4% $10 Chuck E. Cheese 8% $10 Carl's Jr. 5% $10 Game Stop 3% $25 Chili's/Macaroni Grill 9% $25 Gymboree 13% $25 Chipotle 10% $10 Home Goods 7% $25 Chevron 1.5% $50 $25 Home Depot 4% Claire's 9% $10 $100 Cofffee Bean & Tea Leaf 9% $25 $25 JCPenneys 5% 8% $10 $100 Dick's Sporting Goods 8% $25 $25 Kohl’s 4% El Pollo Loco 6% $10 $100 Gap/Old Navy/Banana Republic 14% $25 Limited, the 9% $25 Good Stuff Restaurant 10% $10 $25 Lowe's 6% Islands Restaurant 8% $25 $100 iTunes 5% $15 Marie Calendar's 12% $25 7% $10 Office Depot 4% $25 Macy's 10% $25 9% $10 Marshall's /T.J.Maxx 8% $25 5% $10 $25 $25 Murad Spa 15% Pottery Barn 8% $50 $100 Olive Garden/ 9% $25 Ross Dress for Less 8% $25 Pacific Theaters Movie 10% $7 Tickets (Manhattan Mall) Smart & Final 3% $25 $10 $100 P.F. Chang's China Bistro 8% $25 Souplantation 8% $10 Rite Aid 4% $25 Sports Authority 8% $25 See's Candy 23% $15 $25 Target 2% $10 $100 Coffee 7% $25 3% $10 Walgreens 6% $25 The Children's Place 12% $25 Total $25 Walmart/Sam's Club 2%

Order Information: Name: ______$100 $25 Williams-Sonoma 8% Child’s Name & Teacher ______$100 Phone: ______Total

Delivery will be to the child’s Classroom unless you make You may pay with Cash or Check. arrangements with Alex Kaiser. Email her at Make checks payable to ESMS Scrip. ma‐[email protected] or call 626‐372‐1752.