Ville de Marie Academy SCRIP ORDER FORM Name: Date: Grocery $ Amt. % QTY Total Clothing & Accessories $ Amt. % QTY Total Albertsons 100/25 5% $ Ross Dress for Less 25 8% $ Honey Baked Ham 25 12% $ Shoe Carnival 25 5% $ Safeway 100/25 4% $ T.J. Maxx/Marshalls/HomeGoods 25 7% $ Sprouts Farmers Market 100/50 5% $ Department Store Trader Joes (Visa) 100/50 2% $ Dillard's 100/25 9% $ Whole Foods Market 25 3% $ JC Penney 100/25 5% $ Fry's (Visa) 100/50 25% Kohl's 100/50/25 4% $ Macy's 100/25 10% $ Discount Store Nordstrom 25 6% $ Burlington Coat Factory 25 8% $ Sears 250/100/25 4% $ Kmart 50/25 4% $ Sears Auto Service Center 25 4% $ Target 100/50/25 3% $ Stein Mart 25 7% $ Walmart/Sam's Club 100/50/25 2.50% $ Dining - Casual Clothing & Accessories Applebee's 25 8% $ American Eagle Outfitters 25 10% $ Boston Market 10 12% $ Aerostale 25 10% $ Buca di Beppo 25 8% $ Champ's Sports 25 8% $ Buffalo Wild Wings 25 8% $ Claire's 10 9% $ California Pizza Kitchen 25 8% $ Dennis Uniform 10 6% $ Cheesecake Factory 25 6% $ Dressbarn 25 8% $ Chili's Grill & Bar 25 11% $ Famous Footwear 25 8% $ Chuck E. Cheese 10 8% $ Finish Line 25 10% $ Claim Jumper 25 9% $ Foot Locker 25 8% $ Cracker Barrel 25 8% $ Gap 25 14% $ Darden® Restaurants 25 8% $ Icing 10 9% $ Denny's 25 7% $ Lady Foot Locker 25 8% $ Ihop 25 8% $ Lands' End 25 16% $ Logan's Roadhouse 25 10% $ Lane Bryant 25 6% $ LongHorn Steakhouse 25 8% $ Marshalls 100/25 7% $ Macaroni Grill 25 11% $ Men's Wearhouse 25 8% $ Mimis Cafe 25 8% $ Old Navy 25 14% $ Olive Garden 25 8% $ Payless 20 13% $ On The Border 25 11% $ Ville de Marie Academy SCRIP ORDER FORM Dining - Casual $ Amt. % QTY Total Dining - On The Go $ Amt. % QTY Total Outback Steakhouse 25 8% $ Papa Murphy's Pizza 10 8% $ Panda Express 25 8% $ Pizza Hut 10 8% $ Rainforest Cafe 25 9% $ Qdobe Mexican Grill 25 7% $ Red Lobster 25 8% $ Smashburger 10 10% $ Red Robin 25 8% $ Starbucks 25 7% $ Ruby Tuesday 25 8% $ SUBWAY 10 6% $ Texas Roadhouse 25 8% $ Taco Bell 10 5% $ TGI Fridays 25 9% $ Wendy's 10 4% $ Dining - Fine Electronics & Office Black Angus Steakhouse 25 12% $ Best Buy 100/25 4% $ Don & Charlie's Steakhouse 25 12% $ GameStop 25 3% $ P.F. Chang's China Bistro 25 8% $ Office Max 25 5% $ Pei Wei Asian Diner 25 8% $ Staples 100/25 5% $ Ruth's Chris Steakhouse 25 10% $ Entertainment Dining - On The Go AMC Theatres 25 8% $ Arby's 10 8% $ Cinemark Theatres 25 4% Burger King 10 4% $ Barnes & Noble 25 8% $ Carl's Jr. 10 5% $ Red Box 25 8% $ Chipotle Mexican Grill 25 10% $ Gas & Auto Cold Stone Creamery 10 8% $ Auto Zone 25 8% $ Cousins Subs 10 9% $ ARCO 50 2% $ Dairy Queen 10 3% $ Chevron 100/50 2% $ Del Taco 10 7% $ Circle K 100/25 2% $ Domino's 25 8% $ Exxon 50 2% $ Dunkin' Donuts 25 3% $ Jiffy Lube 30 8% $ Einstein Bros. Bagels 25 10% $ Kwik-Trip 25 4% $ In-N-Out Burger 10 10% $ Mobil 50 2% $ El Pollo Loco 10 6% $ Pep Boys 20 4% $ Jack in the Box 15 4% $ Shell 100/50 3% $ Krispy Kreme Doughnuts 10 8% $ PrePaid Gift Card Little Caesar's Pizza 20 8% $ American Express 250/100/50 1.50% $ Panera 10 8% $ Discover 50 1.25% $ Papa John's Pizza 10 8% $ Visa 250/100/50 2% $ Ville de Marie Academy SCRIP ORDER FORM Home Decor $ Amt. % QTY Total Specialty Retailer $ Amt. % QTY Total Bed Bath & Beyond 100/25 7% $ See's Candies 25 9% $ Crate and Barrel 25 8% $ Sephora 20 5% $ Pier 1 Imports 25 9% $ SmartStyle 25 8% $ Pottery Barn 25 8% $ Spafinder Wellness 365 25 12% $ Williams-Sonoma 25 8% $ Supercuts 25 8% $ Home Improvement Toys"R"Us 25 3% $ Ace Hardware 100/25 5% $ ULTA 25 4% $ Lowe's 500/100/25 5% $ UnderArmour 25 11% $ The Home Depot 500/100/25 5% $ Walgreens 25 8% $ Online & Catalog Sporting Goods 1-800-Baskets 50 12% $ American Eagle 25 10% $ 1-800-Flowers 50 12% $ Bass Pro Shops 100/25 10% $ Amazon.com 100/25 3% $ Big 5 Sporting Goods 25 8% $ Groupon.com 25 $ Cabela's 100/25 11% $ iTunes 25 5% $ Dick's Sporting Goods 100/25 8% $ Omaha Steaks 25 11% $ Overstock.com 25 8% $ Shutterfly 25 10% $ Specialty Retailer Place orders by Monday 3:30 pm. American Girl 25 9% $ Questions: Call Nancy 480-947-9441 or 480-495-2803 Babies"R"Us 20 3% $ PAYMENT: Payment is due with all orders Bath & Body Works 25 13% $ You can pay by cash or check (Payable to Ville de Maire) Build-A-Bear Workshop 25 8% $ You can also pay by credit card but the following fees will apply: Container Store 25 9% $ 4% fee will be applied to all Visa/MC orders CVS/pharmacy 25 6% $ 5% fee will be applied to all AMEX orders Disney 25 2% $ For Office Use Only: Great Clips 25 8% $ Name: __________________________________________Date:______________ Hallmark 25 4% $ Order Completed: _______Yes _____NO JoAnn Fabrics 25 6% $ Payment Total: $ _________________ Michaels 25 4% $ ____Cash _____Check # ___________ Osco/Pharmacy 25 4% $ Order Recorded: _______Yes PetSmart 25 5% $ Sally Beauty Supply 25 12% $.