Scrip Order Form - Shrewsbury Christian Academy [PDF]

Ordering Information Name:

Scrip Order Form

Student's Last Name: Phone:

Child's Grade:

Number of Cards: REVISED: 12/3/2012

Retail Stores Aeropostale Amazon.com American Eagle Outfitters American Girl Babies-R-Us Banana Republic (Gap) Barnes & Noble Bookstores Bath & Body Works Bed, Bath & Beyond Brooks Brothers Build-A-Bear Workshop Burlington Coat Factory Cabela's Casual Male XL Champs Sports Children's Place Christmas Tree Shops Claire's Crate and Barrel Crazy 8 Disney Gift Card Dream Dinners Dress Barn DSW Dunham's Sports Eddie Bauer Express Family Christian Stores Fannie May Candies Finish Line Footlocker Stores Gap / Gap Kids / Baby Gap GNC Gymboree Hallmark Harry & David HomeGoods (TJ Maxx) J Crew J Jill Journey's Lands' End Limited LL Bean Maurices Men's Wearhouse

Make all checks payable to Shrewsbury Christian Academy Denomination Rebate Qty $25 7% $25 / $100 3% $25 10% $25 / $100 9% $20 1.5% $25 / $100 14% $10 / $25 / $100 9% $10 / $25 13% $25 / $100 7% $25 16% $25 8% $25 8% $25 / $100 11% $25 9% $25 9% $25 12% $25 / $100 7% $10 9% $25 / $100 8% $25 13% $25 / $100 / $1000 2% $75 8% $25 8% $25 9% $25 8% $25 10% $25 10% $25 9% $10 25% $25 10% $25 9% $25 / $100 14% $25 8% $25 13% $25 4% $25 10% $25 / $100 7% $25 13% $25 8% $25 10% $25 / $100 16% $25 9% $25 / $100 16% $20 7% $25 8%

Total A

Amt

Please send cards home with my child

Retail Stores Motherhood Maternity Office Depot Office Max Old Navy (Gap) Omaha Steaks Overstock.com Payless Shoes Pet Smart Pier 1 Imports Piperlime Pottery Barn Radio Shack Restoration Hardware Ross Dress for Less Sally Beauty Supply See's Candies Shutterfly Sports Authority Staples Sunglass Hut Talbot's Target Toys-R-Us ULTA Walmart Wet Seal White Barn Candle (Bath & Body) Williams-Sonoma Zappos.com

Denomination Rebate Qty $25 8% $25 / $100 4% $25 / $100 5% $25 / $100 14% $25 11% $25 8% $20 13% $25 4% $25 9% $25 14% $25 / $100 8% $25 4% $25 / $100 12% $25 / $100 8% $25 12% $16.90 20% $25 9% $25 / $100 8% $25 / $100 5% $25 12% $25 13% $10 / $25 / $100 2% $20 1.50% $25 4% $25 / $100 / $250 2.50% $25 5% $10 / $25 13% $25 / $100 8% $25 8%

Amt

Restaurants Applebee's Arby's Bahama Breeze Baja Fresh Bob Evans Boston Market Buffalo Wild Wings Burger King California Pizza Kitchen Carrabba'a Italian Grill Chart House Cheesecake Factory Chili's Chipotle Mexican Grill

Denomination $25 / $50 $10 $25 $25 $10 $10 $10 / $25 $10 $10 $25 $25 / $100 $25 $25 $10

Amt

Total B

Rebate Qty 8% 8% 9% 7% 10% 12% 8% 4% 4% 8% 11% 5% 11% 10%

Amount Due:

Restaurants Chuck E Cheese Cold Stone Creamery Cracker Barrel Darden's Restaurant Denny's Domino's Pizza Dunkin Donuts Eat 'n Park Hard Rock Café Honey Baked Ham IHOP KFC Landry's Seafood House Little Caesar's Pizza Longhorn Steakhouse Macaroni Grill (Chili's) Noodles & Company Old Country Buffet Olive Garden (Red Lobster) Outback Steakhouse Panera Bread Papa John's PF Changs Pizza Hut Quiznos Rainforest Café Red Lobster Red Robin Restaurant.com Ruby Tuesday's Ruth's Chris Steak Starbucks Subway Taco Bell Texas Roadhouse TGI Friday's Wendy's

Please call me when cards arrive Denomination $10 $10 $10 / $25 $25 $10 $10 $10 $10 / $25 $25 $10 / $25 $25 $5 $25 / $100 $20 $25 $25 $10 $25 $25 $25 $10 / $25 $10 $25 $10 $10 $25 / $100 $25 $25 $20 $25 $50 $10 / $25 $10 / $50 $10 $25 $25 $10

Total C Total A-C

Please see other side for more gift cards

** Please note this is a mini-list of all the gift cards that the Scrip program offers. If you do not see a particular gift card you are looking for, please check www.shopwithscrip.com for the complete list. You may also sign up online using our school's enrollment Code: F32D365B12463 Thank you!

$

Rebate 8% 8% 9% 9% 7% 8% 3% 10% 10% 12% 8% 8% 9% 8% 9% 11% 8% 5% 9% 8% 9% 8% 8% 8% 10% 9% 9% 9% 50% 8% 10% 7% 3% 5% 8% 9% 4%

Qty

Amt

Page 2

**Please Note : Denominations and Vendors are subject to change without prior notification

Scrip Order Form (con't) Grocery Denomination Giant Food Stores $50 /$100 Safeway $25 / $100 Shoppers Food & Pharmacy (MD only) $25 / $100 ShopRite $25 / $100 Whole Foods Market $25 / $100

Rebate Qty 4% 4% 4% 4% 3%

Amt

Drug Store CVS Pharmacy Rite Aid Walgreens

Denomination $25 / $100 $25 $25 / $100

Rebate Qty 6% 4% 6%

Amt

Gas and Automotive Advance Auto Parts A-Plus (Sunoco) AutoZone BP Gas Chevron Exxon (Mobil) Exxon (Mobil) Gulf Oil Jiffy Lube Pep Boys Sheetz Gasoline Shell Sunoco Texaco Wawa (DE, MD, NJ, PA, VA)

Denomination $25 $50 / $250 $25 $50 / $100 $50 / $100 $50 $250 $25 $30 $20 $25 / $100 $25 / $100 $50 $50 / $100 $25 / $100

Rebate Qty 7% 1.5% 8% 1.5% 1.5% 1.5% 2.5% 1.5% 9% 4% 3% 2.5% 1.5% 1.5% 1.5%

Amt

Denomination Rebate Qty $25 / $100 / $250 3% $25 3% $25 3% $15 / $25 5% $25 4% $25 9%

Amt

Best Buy EB Games GameStop iTunes Radio Shack Shutterfly

Electronics

Home Improvement Ace Hardwre Home Depot Lowe's Home Improvement

Denomination Rebate Qty $25 / $100 4% $25 / $100 / $500 4% $25 / $100 / $500 4%

Amt

Department and Discount Stores Belk Department Store Bloomingdale's Bon-Ton Boscov's Dept. Store Dillard's JC Penney K Mart Kohl's Lord & Taylor Macy's Marshall's (TJ Maxx) Sears T.J. Maxx Tanger Outlets Target

Denomination Rebate Qty $25 7% $25 / $100 12% $25 / $100 8% $25 8% $25 / $100 9% $25 / $100 5% $25 / $50 4% $25 / $100 4% $25 8% $25 / $100 10% $25 / $100 7% $25 / $100 / $250 4% $25 / $100 7% $25 8% $25 / $100 2%

Amt

Craft Stores Jo Ann Fabrics Michaels Crafts Oriental Trading Company

Denomination $25 $25 $25

Rebate Qty 6% 4% 9%

Amt

Sporting Goods Bass Pro Shops Cabela's Dick's Sporting Goods Gander Mountain REI

Denomination $25 / $100 $25 / $100 $25 / $100 $25 $25

Rebate Qty 9% 11% 8% 8% 8%

Amt

Entertainment Denomination $9.50 AMC Theatres / Loews (Gold Ticket) AMC Theatres $25 Loews Cineplex Entertainment (AMC) $25 Regal Entertainment $25 Regal Entertainment (Premiere Ticket) $9.50 $25 United Artist Theatre (Regal) United Artist (Premiere Ticket) $9.50

Rebate Qty 10% 8% 8% 8% 15% 8% 15%

Amt

Service AT&T 125 Minute Card Great Clips Holiday Hair (Regis) MasterCuts (Regis Salons) Regis Salons SmartStyle (Regis) TruGreen

Denomination $9.50 $25 $25 $25 $25 $25 $50

Rebate 20% 8% 8% 8% 8% 8% 5%

Qty

Amt

Travel Avis Rent A Car Best Western International Budget Car Rental Carnival Cruise Lines Celebrity Cruise Lines Comfort Inn Courtyard (Marriott) Fairfield Inn (Marriott) Hyatt Hotels Marriott Hotels & Resorts Renaissance (Marriott) Residence Inn (Marriott) Ritz-Carlton Hotels SpringHill Suites (Marriott) Towne Place Suites (Marriott)

Denomination Rebate $50 8% $25 / $100 12% $50 8% $100 8% $100 9% $25 / $100 4% $50 / $100 / $500 8% $50 / $100 / $500 8% $50 / $100 9% $50 / $100 / $500 8% $50 / $100 / $500 8% $50 / $100 / $500 8% $50 8% $50 / $100 / $500 8% $50 / $100 / $500 8%

Qty

Amt

Rebate 7% 10% 10% 25%

Qty

Amt

Groupon.com Gift Card Wrappers (pack of 10) Gift Card Holiday Wrapper (10 pack) Cascading Gift Card File (10 pocket)

Denomination $25 $2.00 $2.00 $3.00

Other (not listed on order form)

Denomination

Rebate

Qty

Amt

Other

Total F Total D

Total E Total A-C

** Please note this is a mini-list of all the gift cards that the Scrip program offers. If you do not see a particular gift card you are looking for, please check www.glscrip.com for the complete list. You may also sign up online using our school's enrollment Code: F32D365B12463 Thank you!

PLEASE RETURN COMPLETED FORMS TO THE OFFICE Make all checks payable to Shrewsbury Christian Academy

Total D-F TOTAL A-F