SJS Scrip Weekly Order Form Order Total: $
SJS Scrip Weekly Order Form Delivery Method – Circle Your Choice Below
Orders are placed every Monday. Order must be received by 10:00am in the Middle School office. Payment must be received by Friday. Orders will be available for office pick-up on Fridays or sent home via backpack on Fridays. Youngest Student’s Name:
Parent Name:
Backpack Check #:
Date:
Middle School Office Pick-up
Teacher’s Name for Backpack:
Contact Phone Number:
****Bold and italicized retailers are stocked in the SJS Middle School Office (inventory on hand)**** Product
%
QTY
Total
Product
%
Product
% 8%
5% 5%
Outback Steakhouse $25 Overstock.com $25 Panera Bread $10 Panera Bread $25 Papa John’s $10 Payless $20 PetSmart $25 Pier 1 $25 Pizza Hut $10 Pottery Barn $25 Quality Inn $50 Quiznos $10 Radio Shack $25 Red Lobster $25 Ruby Tuesday $25 Sally’s Beauty Supply $25 Sephora $20 Shell $25
4% 2.5%
Jiffy Lube $30
8%
Shell $50
2.5%
8% 4% 4% 16% 16% 8% 8%
Shell $100 Shoe Carnival $25 Shutterfly $25 Staples $25 Starbucks $10 Starbucks $25 Subway $10
2.5% 5% 9% 5% 7% 7% 3%
8%
KFC $5 Kohl’s $25 Kohl’s $100 Lands’ End $25 Lands’ End $100 Little Caesar’s $20 Logan’s Roadhouse $25 Lowe’s $25
4%
T.J. Maxx $25
7%
8%
Lowe’s $100
4%
Taco Bell $10
5%
8% 4% 11% 11%
Lowe’s $500 Lowe’s $1000 Macaroni Grill $25 Marriott Hotels $50
4% 4% 11% 8%
2% 2% 5% 8%
Children’s Place $25 Chili’s Grill $25 Chuck E. Cheese $10
12% 11% 8%
8% 4% 8%
Cinemark Theatres $25 Claire’s $10 Comfort Inn $50 Cracker Barrel $10 Cracker Barrel $25 CVS/pharmacy $25 Dick’s Sporting Goods $25
4%
Marriott Hotels $100 Michaels $25 Motherhood Maternity $25 Office Depot $25
Target $25 Target $100 Terminix $50 Texas Roadhouse $25 TGI Friday’s $25 Toys R Us $20 Tru Green $50
4%
Walgreens $25
9% 4% 9% 9% 6% 8%
Office Depot $100 Old Chicago $25 Old Navy $25 Old Navy $100 Olive Garden $25 Oriental Trading $25
4% 6% 14% 14% 9% 9%
Walgreens $100 Walmart/Sams $25 Walmart/Sams $100 Walmart/Sams $250 Wendy’s $10 Zappos.com $25
4% 7% 7% 4% 4% 10% 9% 9% 8% 8% 8% 9% 9% 9% 7%
Dick’s Sporting Goods $100 Dillards $25 Dillards $100 Domino’s Pizza $10 Dress Barn $25 Dunkin’ Donuts $10 Exxon Mobil $50 GameStop $25 Gander Mountain $25 Gap $25 Gap $100 Gymboree $25 Hallmark $25 Hardees $10 IHOP $25 iTunes $15
9% 9% 3% 8% 4% 2% 3% 8% 14% 14% 8% 4% 5% 8% 5%
Bass Pro Shops $100 Bath & Body Works $10 Bath & Body Works $25 Bed Bath Beyond $25 Belk $25 Belk $100 Best Buy $25 Best Buy $100 Best Buy $250 BP Gas $50
7% 13%
iTunes $25 JCPenney $25
13% 7% 8% 8% 3% 3% 3% 2%
Buffalo Wild Wings $10 Buffalo Wild Wings $25 Build-A-Bear $25 Burger King $10 Cabela’s $25 Cabela’s $100
Ace Hardware $25
4%
Ace Hardware $100 Advance Auto $25 Aeropostale $25 Amazon.com $25 Amazon.com $100 American Eagle $25 American Girl $25 American Girl $100 Applebee’s $25 Arby’s $10 Autozone $25 Barnes & Noble $10 Barnes & Noble $25 Barnes & Noble $100 Bass Pro Shops $25
QTY
8%
Go to www.shopwithscrip.com to see a full list of Scrip Retailers If you have any questions, call (501) 327-1204 or email [email protected]
Total
Order Total:
QTY
8% 9% 9% 8% 13% 4% 9% 8% 8% 4% 10% 4% 9% 8% 12%
9% 1.5% 5% 6% 6% 2.5% 2.5% 2.5% 4% 8%
$
Total
Orders are placed every Monday. Order must be received by 10:00am in the Middle School office. Payment must be received by Friday. Orders will be available for office pick-up on Fridays or sent home via backpack on Fridays. Youngest Student’s Name:
Parent Name:
Backpack Check #:
Date:
Middle School Office Pick-up
Teacher’s Name for Backpack:
Contact Phone Number:
****Bold and italicized retailers are stocked in the SJS Middle School Office (inventory on hand)**** Product
%
QTY
Total
Product
%
Product
% 8%
5% 5%
Outback Steakhouse $25 Overstock.com $25 Panera Bread $10 Panera Bread $25 Papa John’s $10 Payless $20 PetSmart $25 Pier 1 $25 Pizza Hut $10 Pottery Barn $25 Quality Inn $50 Quiznos $10 Radio Shack $25 Red Lobster $25 Ruby Tuesday $25 Sally’s Beauty Supply $25 Sephora $20 Shell $25
4% 2.5%
Jiffy Lube $30
8%
Shell $50
2.5%
8% 4% 4% 16% 16% 8% 8%
Shell $100 Shoe Carnival $25 Shutterfly $25 Staples $25 Starbucks $10 Starbucks $25 Subway $10
2.5% 5% 9% 5% 7% 7% 3%
8%
KFC $5 Kohl’s $25 Kohl’s $100 Lands’ End $25 Lands’ End $100 Little Caesar’s $20 Logan’s Roadhouse $25 Lowe’s $25
4%
T.J. Maxx $25
7%
8%
Lowe’s $100
4%
Taco Bell $10
5%
8% 4% 11% 11%
Lowe’s $500 Lowe’s $1000 Macaroni Grill $25 Marriott Hotels $50
4% 4% 11% 8%
2% 2% 5% 8%
Children’s Place $25 Chili’s Grill $25 Chuck E. Cheese $10
12% 11% 8%
8% 4% 8%
Cinemark Theatres $25 Claire’s $10 Comfort Inn $50 Cracker Barrel $10 Cracker Barrel $25 CVS/pharmacy $25 Dick’s Sporting Goods $25
4%
Marriott Hotels $100 Michaels $25 Motherhood Maternity $25 Office Depot $25
Target $25 Target $100 Terminix $50 Texas Roadhouse $25 TGI Friday’s $25 Toys R Us $20 Tru Green $50
4%
Walgreens $25
9% 4% 9% 9% 6% 8%
Office Depot $100 Old Chicago $25 Old Navy $25 Old Navy $100 Olive Garden $25 Oriental Trading $25
4% 6% 14% 14% 9% 9%
Walgreens $100 Walmart/Sams $25 Walmart/Sams $100 Walmart/Sams $250 Wendy’s $10 Zappos.com $25
4% 7% 7% 4% 4% 10% 9% 9% 8% 8% 8% 9% 9% 9% 7%
Dick’s Sporting Goods $100 Dillards $25 Dillards $100 Domino’s Pizza $10 Dress Barn $25 Dunkin’ Donuts $10 Exxon Mobil $50 GameStop $25 Gander Mountain $25 Gap $25 Gap $100 Gymboree $25 Hallmark $25 Hardees $10 IHOP $25 iTunes $15
9% 9% 3% 8% 4% 2% 3% 8% 14% 14% 8% 4% 5% 8% 5%
Bass Pro Shops $100 Bath & Body Works $10 Bath & Body Works $25 Bed Bath Beyond $25 Belk $25 Belk $100 Best Buy $25 Best Buy $100 Best Buy $250 BP Gas $50
7% 13%
iTunes $25 JCPenney $25
13% 7% 8% 8% 3% 3% 3% 2%
Buffalo Wild Wings $10 Buffalo Wild Wings $25 Build-A-Bear $25 Burger King $10 Cabela’s $25 Cabela’s $100
Ace Hardware $25
4%
Ace Hardware $100 Advance Auto $25 Aeropostale $25 Amazon.com $25 Amazon.com $100 American Eagle $25 American Girl $25 American Girl $100 Applebee’s $25 Arby’s $10 Autozone $25 Barnes & Noble $10 Barnes & Noble $25 Barnes & Noble $100 Bass Pro Shops $25
QTY
8%
Go to www.shopwithscrip.com to see a full list of Scrip Retailers If you have any questions, call (501) 327-1204 or email [email protected]
Total
Order Total:
QTY
8% 9% 9% 8% 13% 4% 9% 8% 8% 4% 10% 4% 9% 8% 12%
9% 1.5% 5% 6% 6% 2.5% 2.5% 2.5% 4% 8%
$
Total
