St. Mary's SCRIP Order Form [email protected] (740) 362-8961 (ext 5) Name: Family to be credited: Phone Number: Payment: Purchased By (Signature) Date: Cash / Check # Method of Delivery: PICKUP / SEND HOME Vendor Name Profit Price Qty Total Vendor Name Profit Price Qty Total Advance Auto Parts 6.74% $25.00 Cracker Barrel 8.74% $10.00 Aeropostale 6.74% $25.00 Cracker Barrel 8.74% $25.00 Amato's Pizza 15.00% $25.00 CVS/Pharmacy 5.74% $25.00 Amazon.com 3.74% $25.00 CVS/Pharmacy 5.74% $100.00 American Eagle Outfitters 8.74% $25.00 Dave & Buster 12.74% $25.00 Andersons 3.74% $25.00 Dick's Sporting Goods 7.74% $25.00 Andersons 3.74% $100.00 Disney 1.74% $25.00 Applebee's 7.74% $25.00 Domino's Pizza 7.74% $10.00 Arby's 7.74% $10.00 Donatos Pizza 9.74% $10.00 Auto Zone 7.74% $25.00 Eddie Bauer 9.74% $25.00 Barnes & Nobles 8.74% $10.00 Educational Apparel 10.00% $10.00 Barnes & Nobles 8.74% $25.00 Educational Apparel 10.00% $25.00 Bass Pro Shop 11.74% $25.00/100.00 Exxon 1.24% $50.00 Bath & Body Works 12.74% $10.00 Finish Line 9.74% $25.00 Bath & Body Works 12.74% $25.00 First Choice Haircutters 7.74% $25.00 Bed Bath & Beyond 6.74% $25.00 GameStop 2.74% $25.00 Best Buy 2.74% $25.00 GFS Marketplace 3.74% $25.00 Best Buy 2.74% $100.00 GFS Marketplace 3.74% $100.00 Bob Evans 9.74% $10.00 Giant Eagle 5.00% $25.00 Boston Market 11.74% $10.00 Giant Eagle 5.00% $50.00 BP Gas 1.24% $50.00 Giant Eagle 5.00% $100.00 Buca di Beppo 7.74% $25.00 Graeter's Ice Cream 10.00% $10.00 Buehlers 4.00% $25.00 Great Clips 7.74% $25.00 Buehlers 4.00% $50.00 Groupon 6.74% $25.00 Buehlers 4.00% $100.00 Gymboree 12.74% $25.00 Buffalo Wild Wings 7.74% $10.00 Hallmark 3.74% $25.00 Bun's Restaurant 15.00% $25.00 Home Depot 3.74% $25.00 Burger King 3.74% $10.00 Home Depot 3.74% $100.00 Cabella's 10.74% $25.00 Honey Baked Ham 11.74% $25.00 Cabella's 10.74% $100.00 Hungry Howies Pizza 5.00% $5.00 Cashmans 5.00% $25.00 Hyatt Hotels 8.74% $100.00 Cheesecake Factory 4.74% $25.00 Ihop 7.74% $25.00 Children's Place 11.74% $25.00 iTunes 4.74% $15.00 Chili's/Macaroni Grill 11.00% $25.00 JCPenney 4.74% $25.00 Chipotle Mexican Grill 9.74% $10.00 Jiffy Lube 7.74% $30.00 Claire's 8.74% $10.00 Jo-Ann Fabrics 5.74% $25.00 Cold Stone Creamery 7.74% $10.00 KFC 7.74% $5.00 St. Mary's SCRIP Order Form Kohl's(OK for account payment) 5.00% $25.00 Rocky's Italian Ice 15.00% $5.00 Kohl's(OK for account payment) 5.00% $50.00 Rocky's Italian Ice 15.00% $10.00 Kohl's(OK for account payment) 5.00% $100.00 Ruby Tuesday 7.74% $25.00 L.L. Bean 14.74% $25.00 Sally Beauty Supply 11.74% $25.00 L.L. Bean 14.74% $100.00 Saturday's Hair Salon/Regis 7.74% $25.00 Land's End 15.74% $25.00 Sears / Great Indoors 3.74% $25.00 Land's End 15.74% $100.00 Sears / Great Indoors 3.74% $100.00 Limited 8.74% $25.00 Shell 2.24% $25.00 Lowe's 3.74% $25.00 Shell 2.24% $100.00 Lowe's 3.74% $100.00 Shutterfly 8.74% $25.00 Macy's 9.74% $25.00 Spagettii Warehouse 17.74% $20.00 Macy's 9.74% $100.00 Speedway 3.74% $25.00 Marathon 2.74% $25.00 Speedway 3.74% $100.00 Marathon 2.74% $100.00 Speedway (Food Court ONLY) 6.74% $20.00 Marshalls/TJ Max/Home Goods 6.74% $25.00 Sports Authority 7.74% $25.00 Marriott Hotels 7.74% $100.00 Staples 4.74% $25.00 Maurices 6.74% $20.00 Starbucks 6.74% $10.00 Meijer 2.74% $25.00 Starbucks 6.74% $25.00 Meijer 2.74% $100.00 Steak 'n Shake 7.74% $10.00 Michales 3.74% $25.00 Subway 2.74% $10.00 Mimi's Cafe 7.74% $25.00 Talbot 12.74% $25.00 Noodle's & Company 7.74% $10.00 Target 1.74% $25.00 O'Charley's 12.74% $25.00 Target 1.74% $100.00 Old Navy / Gap 8.74% $25.00 Texas Roadhouse 7.74% $25.00 Office Max 4.74% $25.00 TGI Friday's 8.74% $25.00 Outback Steakhouse/Bonefish 7.74% $25.00 Tim Horton's 4.74% $10.00 P.F. Chang's 7.74% $25.00 Toy-R-Us/Babies-R-Us 1.24% $20.00 Panera Bread 8.74% $10.00 Vaquero's 10.00% $5.00 Panera Bread 8.74% $25.00 Vaquero's 10.00% $10.00 Papa John's Pizza 7.74% $10.00 Walgreens 5.74% $25.00 Payless Shoes 12.74% $20.00 Walgreens 5.74% $100.00 PetSmart 3.74% $25.00 Walmart 2.50% $25.00 Pier 1 Imports 8.74% $25.00 Walmart 2.50% $100.00 Pizza Hut 7.74% $10.00 Wendy's 3.74% $10.00 Pottery Barn/Williams Sonoma 7.74% $25.00 Whole Foods 2.74% $25.00 Qdoba Mexican Grill 6.74% $25.00 Whole Foods 2.74% $100.00 Red Lobster/Olive Garden 8.74% $25.00 Zappos.com 7.74% $25.00 Red Robin 8.74% $25.00 Total Amount Ordered: Cards: $ Scrip Volunteer's Name:.