St. Mary's SCRIP Order Form [email protected] (740) 362-8961 (ext 5)
Name: Family to be credited: Phone Number: Payment: Purchased By (Signature) Date: Cash / Check # Method of Delivery: PICKUP / SEND HOME
Vendor Name Profit Price Qty Total Vendor Name Profit Price Qty Total
Advance Auto Parts 6.74% $25.00 Cracker Barrel 8.74% $10.00
Aeropostale 6.74% $25.00 Cracker Barrel 8.74% $25.00
Amato's Pizza 15.00% $25.00 CVS/Pharmacy 5.74% $25.00
Amazon.com 3.74% $25.00 CVS/Pharmacy 5.74% $100.00
American Eagle Outfitters 8.74% $25.00 Dave & Buster 12.74% $25.00
Andersons 3.74% $25.00 Dick's Sporting Goods 7.74% $25.00
Andersons 3.74% $100.00 Disney 1.74% $25.00
Applebee's 7.74% $25.00 Domino's Pizza 7.74% $10.00
Arby's 7.74% $10.00 Donatos Pizza 9.74% $10.00
Auto Zone 7.74% $25.00 Eddie Bauer 9.74% $25.00
Barnes & Nobles 8.74% $10.00 Educational Apparel 10.00% $10.00
Barnes & Nobles 8.74% $25.00 Educational Apparel 10.00% $25.00
Bass Pro Shop 11.74% $25.00/100.00 Exxon 1.24% $50.00
Bath & Body Works 12.74% $10.00 Finish Line 9.74% $25.00
Bath & Body Works 12.74% $25.00 First Choice Haircutters 7.74% $25.00
Bed Bath & Beyond 6.74% $25.00 GameStop 2.74% $25.00
Best Buy 2.74% $25.00 GFS Marketplace 3.74% $25.00
Best Buy 2.74% $100.00 GFS Marketplace 3.74% $100.00
Bob Evans 9.74% $10.00 Giant Eagle 5.00% $25.00
Boston Market 11.74% $10.00 Giant Eagle 5.00% $50.00
BP Gas 1.24% $50.00 Giant Eagle 5.00% $100.00
Buca di Beppo 7.74% $25.00 Graeter's Ice Cream 10.00% $10.00
Buehlers 4.00% $25.00 Great Clips 7.74% $25.00
Buehlers 4.00% $50.00 Groupon 6.74% $25.00
Buehlers 4.00% $100.00 Gymboree 12.74% $25.00
Buffalo Wild Wings 7.74% $10.00 Hallmark 3.74% $25.00
Bun's Restaurant 15.00% $25.00 Home Depot 3.74% $25.00
Burger King 3.74% $10.00 Home Depot 3.74% $100.00
Cabella's 10.74% $25.00 Honey Baked Ham 11.74% $25.00
Cabella's 10.74% $100.00 Hungry Howies Pizza 5.00% $5.00
Cashmans 5.00% $25.00 Hyatt Hotels 8.74% $100.00
Cheesecake Factory 4.74% $25.00 Ihop 7.74% $25.00
Children's Place 11.74% $25.00 iTunes 4.74% $15.00
Chili's/Macaroni Grill 11.00% $25.00 JCPenney 4.74% $25.00
Chipotle Mexican Grill 9.74% $10.00 Jiffy Lube 7.74% $30.00
Claire's 8.74% $10.00 Jo-Ann Fabrics 5.74% $25.00
Cold Stone Creamery 7.74% $10.00 KFC 7.74% $5.00 St. Mary's SCRIP Order Form
Kohl's(OK for account payment) 5.00% $25.00 Rocky's Italian Ice 15.00% $5.00
Kohl's(OK for account payment) 5.00% $50.00 Rocky's Italian Ice 15.00% $10.00
Kohl's(OK for account payment) 5.00% $100.00 Ruby Tuesday 7.74% $25.00
L.L. Bean 14.74% $25.00 Sally Beauty Supply 11.74% $25.00
L.L. Bean 14.74% $100.00 Saturday's Hair Salon/Regis 7.74% $25.00
Land's End 15.74% $25.00 Sears / Great Indoors 3.74% $25.00
Land's End 15.74% $100.00 Sears / Great Indoors 3.74% $100.00
Limited 8.74% $25.00 Shell 2.24% $25.00
Lowe's 3.74% $25.00 Shell 2.24% $100.00
Lowe's 3.74% $100.00 Shutterfly 8.74% $25.00
Macy's 9.74% $25.00 Spagettii Warehouse 17.74% $20.00
Macy's 9.74% $100.00 Speedway 3.74% $25.00
Marathon 2.74% $25.00 Speedway 3.74% $100.00
Marathon 2.74% $100.00 Speedway (Food Court ONLY) 6.74% $20.00
Marshalls/TJ Max/Home Goods 6.74% $25.00 Sports Authority 7.74% $25.00
Marriott Hotels 7.74% $100.00 Staples 4.74% $25.00
Maurices 6.74% $20.00 Starbucks 6.74% $10.00
Meijer 2.74% $25.00 Starbucks 6.74% $25.00
Meijer 2.74% $100.00 Steak 'n Shake 7.74% $10.00
Michales 3.74% $25.00 Subway 2.74% $10.00
Mimi's Cafe 7.74% $25.00 Talbot 12.74% $25.00
Noodle's & Company 7.74% $10.00 Target 1.74% $25.00
O'Charley's 12.74% $25.00 Target 1.74% $100.00
Old Navy / Gap 8.74% $25.00 Texas Roadhouse 7.74% $25.00
Office Max 4.74% $25.00 TGI Friday's 8.74% $25.00
Outback Steakhouse/Bonefish 7.74% $25.00 Tim Horton's 4.74% $10.00
P.F. Chang's 7.74% $25.00 Toy-R-Us/Babies-R-Us 1.24% $20.00
Panera Bread 8.74% $10.00 Vaquero's 10.00% $5.00
Panera Bread 8.74% $25.00 Vaquero's 10.00% $10.00
Papa John's Pizza 7.74% $10.00 Walgreens 5.74% $25.00
Payless Shoes 12.74% $20.00 Walgreens 5.74% $100.00
PetSmart 3.74% $25.00 Walmart 2.50% $25.00
Pier 1 Imports 8.74% $25.00 Walmart 2.50% $100.00
Pizza Hut 7.74% $10.00 Wendy's 3.74% $10.00
Pottery Barn/Williams Sonoma 7.74% $25.00 Whole Foods 2.74% $25.00
Qdoba Mexican Grill 6.74% $25.00 Whole Foods 2.74% $100.00
Red Lobster/Olive Garden 8.74% $25.00 Zappos.com 7.74% $25.00
Red Robin 8.74% $25.00 Total Amount Ordered: Cards: $ Scrip Volunteer's Name: