Order Form (Special) Name: Date: / / Phone: ( ) - Total: $ Check #: All Orders Must Be Prepaid

St. Nicholas Catholic School Order Form (Special) Name: Date: / / Phone: ( ) - Total: $ Check #: All orders must be prepaid. Allow two weeks for delivery. Pickup/Delivery (Please select one): Not Selected Pickup in office Send w/ Child Books & Entertainment Qty Amount Kid's Stuff Qty Amount Amazon.com (S) (3%) $100 American Girl (9%) $25 AMC Theatres (S) (8%) $25 American Girl (9%) $100 AMC Theatres Green Ticket (10%) $10.5 Build-A-Bear Workshop (S) (8%) $25 Barnes & Noble (S) (9%) $100 Crazy 8 (13%) $25 Edwards Theatres (S) (8%) $25 Disney (2%) $25 Edwards Theatres Premiere Ticket (S) (10%) $10 Disney (2%) $100 Krispy Kreme (8%) $25 Disney (2%) $1000 Pilot Flying J (2%) $100 Gymboree (13%) $25 Regal Premiere Ticket (S) (10%) $10 Toys"R"Us/Babies"R"Us (S) (3%) $20 Regal Theatres (S) (8%) $25 Toys"R"Us/Babies"R"Us (S) (3%) $100 Discount Stores Qty Amount Miscellaneous Qty Amount Overstock.com (S) (8%) $25 American Express (1.25%) $25 Target (S) (2.5%) $50 American Express (1.25%) $100 Electronics & Office Qty Amount American Express (1.25%) $200 Best Buy (S) (3%) $250 Groupon.com (S) (7%) $25 Dell Computer (S) (4%) $100 Pet Care Qty Amount Office Depot (5%) $25 PetSmart (4%) $25 Office Depot (5%) $100 Restaurants Qty Amount Office Max (5%) $100 Applebee's (S) (8%) $50 Staples (S) (5%) $25 Baja Fresh (7%) $25 Staples (S) (5%) $100 Buca di Beppo (S) (8%) $25 Gas & Auto Qty Amount Buffalo Wild Wings (S) (8%) $10 Auto Zone (8%) $25 Buffalo Wild Wings (S) (8%) $25 BP (1.5%) $50 California Pizza Kitchen (S) (8%) $10 BP (1.5%) $100 Chipotle Mexican Grill (S) (10%) $10 Chevron/Texaco (1%) $100 Claim Jumper (S) (9%) $25 Chevron/Texaco (1%) $250 Coffee Bean & Tea Leaf (S) (9%) $25 Jiffy Lube (S) (8%) $30 Cracker Barrel (S) (9%) $25 Pilot Flying J (2%) $25 Dave & Buster's (S) (13%) $25 Sinclair Oil (1.5%) $25 Del Taco (4%) $10 Sinclair Oil (1.5%) $100 Einstein Bros. Bagels (10%) $10 Grocery Qty Amount El Pollo Loco (6%) $10 Great Harvest Bread (6%) $10 Fuddruckers (8%) $25 Omaha Steaks (S) (11%) $25 Honey Baked Ham (12%) $25 Vons (4%) $25 IHOP (S) (8%) $25 Vons (4%) $100 Long John Silver's (8%) $10 Whole Foods Market (S) (3%) $25 Mimis Cafe (8%) $25 Whole Foods Market (S) (3%) $100 Noodles & Company (8%) $10 Health & Beauty Qty Amount Old Chicago (6%) $25 CVS/pharmacy (S) (6%) $25 P.F. Chang's/Pei Wei (S) (8%) $25 CVS/pharmacy (S) (6%) $100 Panda Express (8%) $25 GNC (8%) $25 Papa John's Pizza (S) (8%) $10 Rite Aid (4%) $25 Papa Murphy's Pizza (8%) $10 Sephora (S) (5%) $20 Qdoba Mexican Grill (7%) $25 Walgreens (6%) $25 Rainforest Cafe (S) (9%) $25 Walgreens (6%) $100 Rainforest Cafe (S) (9%) $100 Home Improvement Qty Amount Ruth's Chris Steak House (10%) $50 Ace Hardware (4%) $100 TGI Friday's (S) (9%) $25 Bed Bath & Beyond (S) (7%) $100 Retail Qty Amount Crate and Barrel (S) (8%) $25 Burlington Coat Factory (8%) $25 Crate and Barrel (S) (8%) $100 Dillard's (9%) $100 Lowe's (S) (4%) $20 Dressbarn (8%) $25 Lowe's (S) (4%) $500 Express/Express for Men (S) (10%) $25 Lowe's (S) (4%) $1000 Famous Footwear (8%) $25 Pier 1 Imports (9%) $25 Foot Locker (9%) $25 Pottery Barn/Williams Sonoma (S) (8%) $100 Gordmans (7%) $25

St. Nicholas Catholic School - Order Form (Special) Online Scrip Page 1/2 J. Crew (13%) $25 See's Candy (9%) $25 Journeys (10%) $25 Shutterfly (S) (9%) $25 Kohl's* (4%) $100 White Barn Candle Co. (S) (13%) $10 L.L. Bean (S) (16%) $25 White Barn Candle Co. (S) (13%) $25 L.L. Bean (S) (16%) $100 Sporting Goods Qty Amount Land's End (S) (16%) $25 Bass Pro Shops (S) (9%) $25 Land's End (S) (16%) $100 Bass Pro Shops (S) (9%) $100 Lane Bryant (8%) $25 Big 5 Sporting Goods (8%) $25 Macy's (S) (10%) $100 Dick's Sporting Goods (8%) $25 Men's Wearhouse (8%) $25 Dick's Sporting Goods (8%) $100 Nike (S) (12%) $25 Golf Galaxy (4%) $50 Nordstrom/Nordstrom Rack (6%) $25 Travel Qty Amount Ross Dress for Less (8%) $25 Avis Car Rental (8%) $50 Sears/Kmart (S) (4%) $250 Best Western International (12%) $25 Talbots (13%) $25 Best Western International (12%) $100 Under Armour (S) (11%) $25 Budget Car Rental (8%) $50 Zappos.com (S) (8%) $25 Choice Hotels (3%) $50 Zappos.com (S) (8%) $100 Choice Hotels (3%) $100 Specialty Qty Amount Hyatt Hotels (S) (10%) $50 Hallmark (S) (4%) $25 Hyatt Hotels (S) (10%) $100 Harry & David (S) (9%) $25 Royal Caribbean (S) (9%) $100 Jo-Ann Fabric (6%) $25 Southwest Airlines (S) (4%) $30 Michaels (4%) $25 Popcorn Factory (S) (12%) $50 See's Candy (20%) $19

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