SCRIP ORDER FORM Revised 7-12-21 Check

Catholic Schools of Broome County SCRIP REP USE ONLY SCRIP ORDER FORM Revised 7-12-21 Check #

Order due by: noon on Tuesday July 27, 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______Make Arrangements with Rep 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 13% $ 25 Build-A-Bear Workshop 8% $ 25 Little Venice 10% $ 25 Burger King 4% $ 10 $ 25 Burlington Coat Factory 11% $ 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 Chipotle Mexican Grill 13% $ 25 Vendor % $ QTY Cost Chuck E. Cheese 8% $ 10 Advance Auto Parts 7% $ 25 Cinnabon (Oakdale Mall) 6% $ 25 $ 25 Claire's 9% $ 10 Amazon.com 2.25% $ 100 Cold Stone Creamery 11% $ 10 AMC Single Movie Ticket 10% $ 12 $ 10 Cracker Barrel 8% AMC Theatres 13% $ 25 $ 25 American Eagle 10% $ 25 $ 25 CVS Pharmacy 6% $ 25 $ 100 Applebee's 13% $ 50 Dave & Buster's 15% $ 25 Arby's 12% $ 10 Denny's 7% $ 10 AutoZone 8% $ 25 Dick's Sporting Goods/Golf $ 25 8% $ 10 Galaxy/Field&Stream $ 100 Barnes & Noble 8% $ 25 $ 50 Discover Universal Gift Card $ 100 1.25% $ 100 (valid only in the US) $ 25 $ 250 Bass Pro Shops 10% $ 100 Disney - Theme Parks, Trips, $ 25 $ 10 Cruises, Disney Stores & 4% $ 100 Bath & Body Works 17% $ 25 Disney Music $ 1,000 $ 25 $ 10 Bed Bath & Beyond 9% Domino's Pizza 12% $ 100 $ 25 $ 25 $ 10 Dunkin' Donuts 3% Best Buy 4% $ 100 $ 25 $ 250 Express 10% $ 25 $ 25 Famous Footwear 8% $ 25 Best Western 12% $ 100 Five Below 2.5% $ 25 Blaze Pizza (on Parkway) 13% $ 25 Footlocker / Champs 13% $ 25 Boscov's 10% $ 25 GameStop 3% $ 25 Total "B"= 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) 11% $ 25 Sephora (in JCPenneys) 5% $ 25 $ 25 $ 25 Sheetz 3% $ 100 $ 100 Home Depot 7% $ 500 Shutterfly 11.75% $ 25 $ 1,000 $ 10 Sonic 12% IHOP 8% $ 25 $ 25 $ 15 $ 25 iTunes 5% Staples 8% $ 25 $ 100 J. Crew 13% $ 25 $ 10 Starbuck's 4.5% $ 25 $ 25 JCPenney (CANNOT pay JCP 6% charge card balances) $ 100 $ 10 Subway 6% Jo Ann Fabrics 6% $ 25 $ 50 Journeys 12.75% $ 25 1% $ 50 Sunoco $ 25 1% $ 250 Kohl's (CAN pay Kohl's charge card 4% balances) $ 100 Sweet Frog 10% $ 10 $ 25 Taco Bell 5% $ 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 10% $ 25 Lowe's Home $ 100 TGI Friday's 12% $ 25 4% Improvement $ 500 The Children's Place 14% $ 25 $ 1,000 TJ Maxx / Home Goods / $ 25 9% Men's Wearhouse 8% $ 25 Marshall's $ 100 Michael"s 4% $ 25 Ulta 7% $ 25 Moe's Southwst Grille 6% $ 25 $ 50 $ 25 Visa "5 Back" Gift Card 1.25% $ 100 Old Navy /Gap /BananaRep. 18% (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% Panera Bread 10% $ 25 $ 100 $ 50 $ 25 Weis Markets 5% Papa John's 8% $ 10 $ 100 Pet Smart 5% $ 25 Wendy's 4% $ 10 Pizza Hut 8% $ 10 $ 25 Williams Sonoma / Pottery Barn 8% Red Lobster 8% $ 25 $ 100 Red Robin 8% $ 25 $ 25 Zappos.com 11% 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 14% $ 25 $ 100

Total "D"=

Total "E"= ORDER TOTAL =

Happy Moments is a 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. Remember Lands End for school uniforms. This is the only order before the start of the school year. This is the first order that will be applied to the 2022-23 school year. Any questions, please call Denise Anderson 772-8940