Catholic Schools of Broome County SCRIP REP USE ONLY SCRIP ORDER FORM Revised 5-15-21 Check #

Order due by: noon on Tuesday May 25, 2021 Amount: $

Please make checks payable to: Catholic Schools of Broome County Profit: Purchaser & Student to receive credit: Delivery Information: This Order: $ Name of purchaser: ______PICK UP AT SCHOOL OFFICE Phone # ______Grade Of Student______Send Home with My Student This Year: $ Student to receive credit: ______in Grade ______Email addess: Important note -- Once SCRIP is delivered to the student, the SCRIP ______rep is no longer responsible for lost or stolen gift cards. Local Vendor % $ QTY Cost Vendor % $ QTY Cost $ 10 Food & Fire 10% $ 25 Buffalo Wild Wings 8% $ 25 Build-A-Bear Workshop 8% $ 25 Little Venice 10% $ 25 4% $ 10 $ 25 Burlington Coat Factory 8% $ 25 McCoy's Chophouse 10% $ 50 $ 25 Cabela's 10% $ 100 Carter's / OshKosh 10% $ 25 Catherine's/LaneBryant/Cacique 8% $ 25 $ 25 Chili's / Macaroni Grill 11% $ 50 Total "A"= $ 10 10% $ 25 Vendor % $ QTY Cost Chuck E. Cheese 8% $ 10 Advance Auto Parts 7% $ 25 (Oakdale Mall) 6% $ 25 $ 25 Claire's 9% $ 10 Amazon.com 2.25% $ 100 11% $ 10 AMC Single Movie Ticket 10% $ 12 Comfort Hotels - Comfort, $ 50 4% AMC Theatres 8% $ 25 Quality, Clarion, Sleep, etc. $ 100 American Eagle 10% $ 25 $ 10 Cracker Barrel 8% $ 25 $ 25 Applebee's 8% $ 50 $ 25 CVS Pharmacy 6% Arby's 8% $ 10 $ 100 AutoZone 8% $ 25 Dave & Buster's 13% $ 25 $ 10 Denny's 7% $ 10 Barnes & Noble 8% $ 25 Dick's Sporting Goods/Golf $ 25 8% $ 100 Galaxy/Field&Stream $ 100 $ 25 $ 50 Bass Pro Shops 10% Discover Universal Gift Card $ 100 1.25% $ 100 (valid only in the US) $ 10 $ 250 Bath & Body Works 12% $ 25 Disney - Theme Parks, Trips, $ 25 Bed Bath & Beyond / $ 25 Cruises, Disney Stores & 3% $ 100 7% Christmas Tree Shops $ 100 Disney Music $ 1,000 $ 25 $ 10 Domino's Pizza 8% Best Buy 4% $ 100 $ 25 $ 250 $ 10 Dunkin' Donuts 3% $ 25 $ 25 Best Western 12% $ 100 Express 10% $ 25 Blaze Pizza (on Parkway) 10% $ 25 Famous Footwear 8% $ 25 Boscov's 8% $ 25 Five Below 2.5% $ 25 Total "B"= Footlocker / Champs 8% $ 25 GameStop 3% $ 25 Guitar Center 4% $ 25 Gulf Oil 1.5% $ 25 Total "C"= Check www.ShopWithScrip.com for a complete list of retailers available and the latest bonuses! Vendor % $ QTY Cost Vendor % $ QTY Cost Happy Moments (see below) 8% $ 25 Sephora (in JCPenneys) 5% $ 25 $ 25 $ 25 Sheetz 3% $ 100 $ 100 Home Depot 4% $ 500 Shutterfly 9% $ 25 $ 1,000 $ 10 Sonic 8% IHOP 8% $ 25 $ 25 $ 15 $ 25 iTunes 5% Staples 5% $ 25 $ 100 J. Crew 13% $ 25 $ 10 Starbuck's 4.5% $ 25 $ 25 JCPenney (CANNOT pay JCP 5% charge card balances) $ 100 $ 10 6% Jo Ann Fabrics 6% $ 25 $ 50 Journeys 10% $ 25 1% $ 50 Sunoco $ 25 1% $ 250 Kohl's (CAN pay Kohl's charge card 4% balances) $ 100 Sweet Frog 10% $ 10 $ 25 6% $ 10 Lands' End 15% $ 100 Talbot's 13% $ 25 Little Caesar's Pizza 8% $ 20 $ 25 $ 25 Target 2.5% $ 50 LL Bean 16% $ 100 $ 100 $ 25 Texas Roadhouse 8% $ 25 Lowe's Home $ 100 TGI Friday's 9% $ 25 4% Improvement $ 500 The Children's Place 12% $ 25 $ 1,000 TJ Maxx / Home Goods / $ 25 7% Men's Wearhouse 8% $ 25 Marshall's $ 100 Michael"s 4% $ 25 Ulta 4% $ 25 Moe's Southwst Grille 6% $ 25 $ 50 $ 25 Visa "5 Back" Gift Card 1.25% $ 100 Old Navy /Gap /BananaRep. 14% (valid only in the US) $ 100 $ 250 Olive Garden 8% $ 25 $ 25 $ 25 $ 50 Outback / Carrabba's 10% Walmart / Sam's Club 2.5% $ 50 $ 100 P.F. Chang's 8% $ 25 $ 250 $ 10 $ 25 Walgreen's 5% 8% $ 25 $ 100 $ 50 $ 25 Weis Markets 5% Papa John's 9% $ 10 $ 100 Pet Smart 5% $ 25 Wendy's 4% $ 10 8% $ 10 $ 25 Williams Sonoma / Pottery Barn 8% 8% $ 25 $ 100 8% $ 25 $ 25 Zappos.com 8% Regal Single Movie Ticket 10% $10.50 $ 100 Regal Entertainment 8% $ 25 Gift Card Wrappers 10% $ 2 Regis Salons 8% $ 25 Cascading Gift Card File 25% $ 3 Ruby Tuesdays 8% $ 25 $ 25 Speedway 4% Sally Beauty 12% $ 25 $ 100

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Total "E"= ORDER TOTAL =

Happy Moments is a new card that can be used at the following vendors: Cheesecake Factory, Macy's, Red Lobster, Regal, Sephora, Buffalo Wild Wings and Bed Bath and Beyond. Rememeber Father's Day and Graduations in June This is the LAST order for this school year. There will be a summer order, date to be determined (most likely the end July/early Aug). Any questions, please call Denise Anderson 772-8940 Low Denominations cards will be available while supply lasts. If the cards are not available at the time we place the order, you will receive a credit on your next scrip order These cards make great graduation as teachers gifts Include this form with your regular scrip order form and add the two totals together into your check.

Vendor % $ QTY Cost Amazon.com 2.25% $ 10 Applebee's 8% $ 10 Take advantage of these special offers now! Barnes & Noble 8% $ 5 Coldstone 11% $ 5 CVS 6% $ 10 Home Depot 4% $ 10 IHOP 8% $ 10 Olive Garden 8% $ 10 Outback 10% $ 10 Any questions, please call Denise Anderson 772-8940 Panera 8% $ 5 Red Lobster 8% $ 10 4.5% $ 5 Taco Bell 6% $ 5 Target 2.5% $ 10 Walmart 2.5% $ 10 Total Extras =