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| 1 |
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SCRIP
ORDER FORM |
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| 2 |
Name:_________________________________Date:____________ |
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| 3 |
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Dr.
Howard PTA |
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| 4 |
Phone:__________________Check#:_________Amount:_______ |
Contacts |
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| 5 |
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Contact info: |
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| 6 |
Teacher:_______________________________________________ |
Phone:__________________Cell:________________ |
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| 9 |
Item |
Description |
Qty |
Price |
Total |
Item |
Description |
Qty |
Price |
Total |
|---|
|
10 |
National
Grocery |
|---|
| 11 |
1183 |
Albertsons/Jewel/Osco/SHAW'S
$50 (4%) |
|
$50.00 |
|
1184 |
Albertsons/Jewel/Osco/SHAW'S
$100 (4%) |
|
$100.00 |
|
|---|
| 12 |
1161 |
HEB/Central Market $25 (2%) |
|
$25.00 |
|
1151 |
Safeway $25 (4%) |
|
$25.00 |
|
|---|
| 13 |
1145 |
ShopKo $25 (2%) |
|
$25.00 |
|
|
|
|
|
|
|---|
| 14 |
National
Restaurants |
|---|
| 15 |
214 |
Applebee's $25 (8%) |
|
$25.00 |
|
211 |
Applebee's $10 (8%) |
|
$10.00 |
|
|---|
| 16 |
203 |
Arby's National $10 (8%) |
|
$10.00 |
|
216 |
Baskin-Robbins $2 (9%) |
|
$2.00 |
|
|---|
| 17 |
225 |
Bertucci's $25 (10%) |
|
$25.00 |
|
250 |
Black Angus/Cattle Company
$25 (11%) |
|
$25.00 |
|
|---|
| 18 |
234 |
Bob Evans $20 (12%) |
|
$20.00 |
|
226 |
Boston Market $10 (12%) |
|
$10.00 |
|
|---|
| 19 |
229 |
Bruegger's $10 (7%) |
|
$10.00 |
|
233 |
Burger King $10 (4%) |
|
$10.00 |
|
|---|
| 20 |
236 |
Carl's Jrs. $10 |
|
$10.00 |
|
300 |
Cheesecake Factory $25 (3%) |
|
$25.00 |
|
|---|
| 21 |
302 |
Chili's $10 (11%) |
|
$10.00 |
|
303 |
Chili's $25 (11%) |
|
$25.00 |
|
|---|
| 22 |
311 |
Chuck E. Cheese $10 (8%) |
|
$10.00 |
|
296 |
Cold Stone Creamery $10
(8%) |
|
$10.00 |
|
|---|
| 23 |
282 |
Cracker Barrel $10 (9%) |
|
$10.00 |
|
283 |
Cracker Barrel $25 (9%) |
|
$25.00 |
|
|---|
| 24 |
320 |
Dave & Buster's $25
(14%) |
|
$25.00 |
|
325 |
Denny's $10 (7%) |
|
$10.00 |
|
|---|
| 25 |
327 |
Domino's Pizza $10 (8%) |
|
$10.00 |
|
32750 |
Dominos $50 (8%) |
|
$50.00 |
|
|---|
| 26 |
323 |
Dream Dinners $75 (8%) |
|
$75.00 |
|
324 |
Dunkin Donuts $10 (4%) |
|
$10.00 |
|
|---|
| 27 |
373 |
Friendly's $5 (7%) |
|
$5.00 |
|
328 |
Great Harvest Bread Company
$10 (8%) |
|
$10.00 |
|
|---|
| 28 |
382 |
Hard Rock Cafe $25 (8%) |
|
$25.00 |
|
381 |
KFC $5 (9%) |
|
$5.00 |
|
|---|
| 29 |
384 |
Long John Silver's $5 (9%) |
|
$5.00 |
|
397 |
Marie Callender's $25 (13%) |
|
$25.00 |
|
|---|
| 30 |
405 |
Noodles Restaurants $25
(4%) |
|
$25.00 |
|
402 |
O'Charley's $25 (13%) |
|
$25.00 |
|
|---|
| 31 |
404 |
Old Country Buffet/Ryans
$25 (8%) |
|
$25.00 |
|
343 |
OliveGarden/RedLobster/LONGHORN/BahamaBreeze/TheCapitalGrill/Seasons52
$25 (9%) |
|
$25.00 |
|
|---|
| 32 |
820 |
Panera Bread $10 (9%) |
|
$10.00 |
|
411 |
PaPa John's Pizza $10 (8%) |
|
$10.00 |
|
|---|
| 33 |
425 |
Piccadilly Pub $25 (8%) |
|
$25.00 |
|
412 |
Pizza Hut $10 (8%) |
|
$10.00 |
|
|---|
| 34 |
441 |
Qdoba Mexican Grill $25
(7%) |
|
$25.00 |
|
450 |
Red Robin $10 (7%) |
|
$10.00 |
|
|---|
| 35 |
464 |
Rocky Mountain Chocolate
Factory $10 (12%) |
|
$10.00 |
|
463 |
Ruby Tuesday's $25 (8%) |
|
$25.00 |
|
|---|
| 36 |
531 |
Starbucks $10 (7%) |
|
$10.00 |
|
532 |
Starbucks $25 (7%) |
|
$25.00 |
|
|---|
| 37 |
536 |
Subway $10 (3%) |
|
$10.00 |
|
485 |
Texas RoadHouse $10 (8%) |
|
$10.00 |
|
|---|
| 38 |
506 |
TGIFriday's $10 (9%) |
|
$10.00 |
|
507 |
TGIFriday's $25 (9%) |
|
$25.00 |
|
|---|
| 39 |
512 |
Wendy's $10 (4%) |
|
$10.00 |
|
|
|
|
|
|
|---|
| 40 |
National
Retailers |
|---|
| 41 |
619 |
American Eagle $25 (8%) |
|
$25.00 |
|
633 |
Bass Pro Shops $25 (8%) |
|
$25.00 |
|
|---|
| 42 |
621 |
Bath & Body Works $10
(18% through Dec. 31, 2009) |
|
$10.00 |
|
622 |
Bath & Body Works $25
(18% through Dec. 31, 2009) |
|
$25.00 |
|
|---|
| 43 |
634 |
Bed, Bath and Beyond $25
(6%) |
|
$25.00 |
|
635 |
Belk's $25 (10%) |
|
$25.00 |
|
|---|
| 44 |
654 |
Claire's $10 (9%) |
|
$10.00 |
|
671 |
Crate and Barrel $25 (4%) |
|
$25.00 |
|
|---|
| 45 |
668 |
Dick's Sporting Goods $25
(5%) |
|
$25.00 |
|
667 |
Dillard's $25 (9%) |
|
$25.00 |
|
|---|
| 46 |
673 |
Disney $25 (2%) |
|
$25.00 |
|
681 |
Eddie Bauer $25 (7%) |
|
$25.00 |
|
|---|
| 47 |
684 |
Express $20 (12%) |
|
$20.00 |
|
682 |
Fashion Bug $25 (7%) |
|
$25.00 |
|
|---|
| 48 |
689 |
Finishline $25 (11%) |
|
$25.00 |
|
686 |
Footlocker $25 (9%) |
|
$25.00 |
|
|---|
| 49 |
691 |
Gap, Old Navy, Banana Republic
$25 (9%) Gap Tri-Card |
|
$25.00 |
|
693 |
Gordmans $25 (7%) |
|
$25.00 |
|
|---|
| 50 |
692 |
Hallmark $25 (4%) |
|
$25.00 |
|
370 |
Harry and David $25 (11%
) |
|
$25.00 |
|
|---|
| 51 |
722 |
JCPenney $25 (7% through
Dec. 18, 2009) |
|
$25.00 |
|
724 |
JCPenneys $100 (7% through
Dec. 18, 2009) |
|
$100.00 |
|
|---|
| 52 |
731 |
Jo-Ann Fabrics $20 (6%) |
|
$20.00 |
|
762 |
Kmart $25 (4%) |
|
$25.00 |
|
|---|
| 53 |
745 |
Kohl's $25 (4%) |
|
$25.00 |
|
746 |
Kohls $100 (4%) |
|
$100.00 |
|
|---|
| 54 |
790 |
Lord & Taylor $25 (8%) |
|
$25.00 |
|
9829 |
Macy's $100 (10%) |
|
$100.00 |
|
|---|
| 55 |
829 |
Macy's $25 (10%) |
|
$25.00 |
|
805 |
Men's WearHouse $25 (7%) |
|
$25.00 |
|
|---|
| 56 |
823 |
Payless Shoes $10 (18% -
Special thru 12/4/09) |
|
$10.00 |
|
818 |
PetSmart $25 (4%) |
|
$25.00 |
|
|---|
| 57 |
825 |
Pier 1 Imports $25 (9%) |
|
$25.00 |
|
804 |
REI Stores $25 (8%) |
|
$25.00 |
|
|---|
| 58 |
824 |
ROSS Dress For Less $25
(9%) |
|
$25.00 |
|
850 |
Sally Beauty $25 (14%) |
|
$25.00 |
|
|---|
| 59 |
830 |
Sears $25 (4%) |
|
$25.00 |
|
828 |
Shoe Carnival $25 (4%) |
|
$25.00 |
|
|---|
| 60 |
8262 |
Sport's Authority $25 (13%) |
|
$25.00 |
|
842 |
Sunglass Hut $25 (9%) |
|
$25.00 |
|
|---|
| 61 |
8525 |
Talbots Gift Card $25 (9%) |
|
$25.00 |
|
851 |
Tanger Outlet Stores $25
(9%) |
|
$25.00 |
|
|---|
| 62 |
863 |
The Container Store $25
(9%) |
|
$25.00 |
|
807 |
TJMaxx/Marshalls/HomeGoods/AJWright
$25 (7%) |
|
$25.00 |
|
|---|
| 63 |
9892 |
Walmart $100 (2%) |
|
$100.00 |
|
9890 |
Walmart $25 (2%) |
|
$25.00 |
|
|---|
| 64 |
997 |
Williams & Sonoma $25
(8%) |
|
$25.00 |
|
|
|
|
|
|
|---|
| 65 |
Childrens
Speciality Stores |
|---|
| 66 |
660 |
Build-A-Bear Workshop $25
(8%) |
|
$25.00 |
|
8472 |
Toys R Us $25 (1.5%) |
|
$25.00 |
|
|---|
| 67 |
846 |
ToysRUs $10 (1.5%) |
|
$10.00 |
|
|
|
|
|
|
|---|
| 68 |
Movie/Entertainment |
|---|
| 69 |
779 |
AMC Loews Cineplex $25 (7%) |
|
$25.00 |
|
661 |
Blockbuster $10 (8%) |
|
$10.00 |
|
|---|
| 70 |
6625 |
Blockbuster $5 (8%) Limited
Supply Only! |
|
$5.00 |
|
669 |
Blockbuster Game Card ($8
value) $7 (27%) |
|
$7.00 |
|
|---|
| 71 |
664 |
Blockbuster Movie Card $4
(19%) |
|
$4.00 |
|
687 |
Goodrich Quality Theaters
$10 (4%) |
|
$10.00 |
|
|---|
| 72 |
697 |
Hollywood Video $25 (16%) |
|
$25.00 |
|
926 |
United Artists/Regal Theaters
$10 (8%) |
|
$10.00 |
|
|---|
| 73 |
Electronic/Technology |
|---|
| 74 |
640 |
Best Buy $100 (3% through
Dec. 31, 2009) |
|
$100.00 |
|
638 |
Best Buy $25 (3% through
Dec. 31, 2009) |
|
$25.00 |
|
|---|
| 75 |
Office
Supplies |
|---|
| 76 |
810 |
Office Depot $25 (3%) |
|
$25.00 |
|
811 |
Office Max $25 (4%) |
|
$25.00 |
|
|---|
| 77 |
839 |
Staples $25 (5%) |
|
$25.00 |
|
|
|
|
|
|
|---|
| 78 |
Catalog
and On-line Stores |
|---|
| 79 |
612 |
Amazon.com $25 (5%) |
|
$25.00 |
|
613 |
Amazon.com $50 (5%) |
|
$50.00 |
|
|---|
| 80 |
623 |
Art.com $25 (8%) |
|
$25.00 |
|
647 |
Cabela's $25 (11%) |
|
$25.00 |
|
|---|
| 81 |
79953 |
Fannie May/ 1-800-Flowers.com/
Plow & Hearth $20 (25%) |
|
$20.00 |
|
712 |
iTunes $25 (4.5%) |
|
$25.00 |
|
|---|
| 82 |
776 |
L.L.Bean $25 (18%) NEW Increased
Discount! |
|
$25.00 |
|
768 |
Land's End $25 (14%) NEW
Increased Discount! |
|
$25.00 |
|
|---|
| 83 |
777 |
Longaberger Baskets $25
(10%) Sue Tell only |
|
$25.00 |
|
814 |
Overstock.com $25 (9%) |
|
$25.00 |
|
|---|
| 84 |
483 |
See's Candies 1 lb $15.00
(25%) |
|
$15.00 |
|
827 |
Shutterfly $25 (9%) |
|
$25.00 |
|
|---|
| 85 |
Pharmacy/Drug
Stores |
|---|
| 86 |
657 |
CVS Gift Card $25 (2%) |
|
$25.00 |
|
935 |
Walgreens $25 (3% - Special
thru 11/27/09) |
|
$25.00 |
|
|---|
| 87 |
Book
Stores |
|---|
| 88 |
626 |
Barnes & Noble $10 (9%) |
|
$10.00 |
|
627 |
Barnes & Noble $25 (9%) |
|
$25.00 |
|
|---|
| 89 |
625 |
Barnes and Noble Teacher
Card $5 (9%) |
|
$5.00 |
|
981 |
Borders Books $10 (9%) |
|
$10.00 |
|
|---|
| 90 |
982 |
Borders Books $25 (9%) |
|
$25.00 |
|
690 |
Family Christian $25 (9%) |
|
$25.00 |
|
|---|
| 91 |
Home
Improvement |
|---|
| 92 |
599100 |
Ace Hardware $100 (4%) |
|
$100.00 |
|
599 |
Ace Hardware $25 (4%) |
|
$25.00 |
|
|---|
| 93 |
702 |
Home Depot $25 (4%) |
|
$25.00 |
|
703 |
Home Depot $50 (4%) |
|
$50.00 |
|
|---|
| 94 |
784 |
Lowe's $100 (4%) |
|
$100.00 |
|
782 |
Lowe's $25 (4%) |
|
$25.00 |
|
|---|
| 95 |
783 |
Lowe's $50 (4%) |
|
$50.00 |
|
792 |
Menards $25 (3%) |
|
$25.00 |
|
|---|
| 96 |
Hotels
and Travel |
|---|
| 97 |
999 |
Carnival Cruise Lines $100
(8%) NOT VALID ON BOARD |
|
$100.00 |
|
1005 |
Choice Hotels $100 (4%) |
|
$100.00 |
|
|---|
| 98 |
674 |
Disney $100 (2%) |
|
$100.00 |
|
1020 |
Hyatt Hotels $25 (8%) |
|
$25.00 |
|
|---|
| 99 |
1003 |
Marriott $100 (9%) |
|
$100.00 |
|
1002 |
Marriott $50 (9%) |
|
$50.00 |
|
|---|
| 100 |
Automobile
Care/Gas Cards |
|---|
| 101 |
931 |
Advance Auto Parts $25 (7%) |
|
$25.00 |
|
962 |
BP $50 (1.5%) |
|
$50.00 |
|
|---|
| 102 |
900 |
Chevron Gas $100 (1.5%) |
|
$100.00 |
|
902 |
Chevron Gas $250 (1.5%)
- Special Order |
|
$250.00 |
|
|---|
| 103 |
901 |
Chevron Gas $50 (1.5%) |
|
$50.00 |
|
952 |
Exxon/Mobil $50 (2%) |
|
$50.00 |
|
|---|
| 104 |
721 |
Jiffy Lube $25 (11% through
Dec. 31, 2009) |
|
$25.00 |
|
976 |
Shell $25 (2.5% - special
through 12/31/09)) |
|
$25.00 |
|
|---|
| 105 |
978 |
Shell $50 (2.5% - special
through 12/31/09)) |
|
$50.00 |
|
989 |
Speedway $50 (4%) |
|
$50.00 |
|
|---|
| 106 |
969 |
Sunoco $50 (1.5%) |
|
$50.00 |
|
|
|
|
|
|
|---|
| 107 |
TOTAL A: |
|
TOTAL B: |
|
|---|
|
108 |
GRAND TOTAL
(TOTAL A+ TOTAL B): |
|
|---|
|
109 |
Note
: |
|---|
| 110 |
|---|
| 111 |
|---|
| 112 |
|---|
| 113 |
|---|
| 114 |
|---|
| 115 |
|---|