BRIGHTON PTO SCRIP ORDER FORM Make checks payable to Brighton PTO Teacher__________________Child_________________________ Name____________________________________________________ I give my child permission to bring my Scrip order home. □ Email_____________________________________Phone____________ I will pick my Scrip order up in the Lower Campus Office. □ Sign____________________________________ Date_____________ Name of Company GAIN AMT QTY TOT Name of Company GAIN AMT QTY TOT Aeropostale (Reloadable) 10% $25 LOWES Hardware $25,$100 (Reloadable) 4% ← Albertsons $25,$100 (Reloadable) 4% ← Macaroni Grill (Chilis) 11% $25 Amazon.com $25,$100 3% ← Macys $25,$100 10% ← AMC Theaters (Loews) Reloadable 8% $25 Michael's 4% $25 American Eagle Outfitters 10% $25 Nordstroms $25, $100 6% ← American Girl $25,$100 9% ← Office Max/Office Depot 5% $25 Applebees 8% $25 Olive Garden/Red Lobster (Reloadable) 9% $25 ARCO $50,$100 (Reloadable) 1.5% ← Outback Steakhouse 8% $25 Azteca 15% $25 PCC Grocery (Reloadable) 5% $25 Barnes & Noble $10,$25 9% ← P. F. Chang's 8% $25 Bath & Body Works $10,$25 (Reloadable) 13% ← Panda Express 8% $25 Bed Bath & Beyond $25,$100 7% ← Panera Bread $10,$25 9% ← Best Buy $25,$100 3% ← Papa Johns (Reloadable) 8% $10 Big 5 Sporting Goods 8% $25 Papa Murphy's 8% $10 Black Angus 12% $25 Petsmart 9% $25 The Body Shop 8% $25 Pier 1 Imports 9% $25 Buca Di Beppo 8% $25 Pizza Hut 8% $10 Buffalo Wild Wings (Reloadable) 8% $25 Pottery Barn / Wm Sonoma $25,$100 8% ← Build A Bear 8% $25 Qdoba Mexican Grill 7% $25 Burger King (Reloadable) 4% $10 QFC (Fred Meyer) $25,$100 5% ← Cabela's $25,$100 11% ← Red Robin 9% $25 Central Market $25,$100 2% ← Regal Cinemas 8% $25 Cheesecake Factory 5% $25 REI 8% $25 Chevron / Texaco (Reloadable) 1.5% $50 Restoration Hardware $25,$100 12% ← Chipotle 10% $10 Rite Aid 4% $25 Chuck E Cheese 8% $10 Ross 8% $25 Claim Jumper's (McCormicks) 9% $25 Ruth's Chris Steakhouse 10% $50 Claires (Icing) 9% $10 Safeway $25,$100 (Reloadable) 4% ← Coldstone 8% $10 Sam Goody $10,$25 5% ← Crate & Barrell $25,$100 8% ← Scotts Restaurants Unlimited $25,$50 20% ← Dairy Queen 3% $10 Sears $25,$100 4% ← Discover $50,$100 1.25% ← See's Candies 9% $25 Disney $25,$100 2% ← Sephora 4% $20 Dominos Pizza 8% $10 76 Gas $25,$100 1.5% ← Double DD Meats 20% $25 Shell Gas $25,$50 (Reloadable) 2.0% ← Eddie Bauer 10% $25 Sport Authority (Reloadable) 8% $25 Express 10% $25 Staples 5% $25 f.y.e. (For Your Entertainment) 6% $25 Starbucks/Teavana (Reloadable) $10,$25 7% ← Game Stop 3% $25 Subway (Reloadable) 6% $10 Gap/Banana Republic/Old Navy (Reloadable)14% $25 Taco Bell (Reloadable) 5% $10 Great Harvest 6% $10 Talbots 13% $25 Groupon 7% $25 Target (Reloadable) $25,$100 2.5% ← Gymboree (Reloadable) 13% $25 TJ Maxx/Marshall's/Home Goods $25,$100 7% ← Hallmark (Reloadable) 4% $25 Tony Romas 12% $20 Home Depot $25,$100 4% ← Toys R Us/Babies R Us (Reloadable) 3% $20 I - Tunes $15,$25 5% ← Tully's 10% $10 J. Crew 13% $25 Ulta 4% $25 J. Jill 8% $25 Walgreens $25,$100 6% ← Jack in the Box 4% $10 Walmart (Sam's Club) $25,$100 2.5% ← JC Penny $25,$100 (Reloadable) 5% ← Wendy's 4% $10 Jiffy Lube (Reloadable) 8% $30 Whole Foods $25,$100 (Reloadable) 3% ← JoAnn Fabrics 6% $25 KOHL's 4% $25 Lands End 16% $25 LL Bean 16% $25 Little Caesars Pizza 8% $20 Lorinda's Spa Salon 10% $50 GRAND TOTAL $______________CHECK #______________ Order filled by _____________ Scrip Contact: Kim Lohr at [email protected] or [email protected] Entry date _____________ revised 02/20/16 !1.