| Family Order Form | Created: 09/09/2009 | |||||||||
| St. Therese Church/Parkville,MO | Orders placed on Tuesday, for Friday delivery | |||||||||
| Name: | ||||||||||
| Check # | Order total: $ | Call/drop in with credit card information | ||||||||
| Apparel & Accessories | Dining - Casual | |||||||||
| Product | % | Qty | Total | Product | % | Qty | Total | |||
| American Eagle Outfitters $25 | 9% | $ | Red Lobster/Olive Garden $25 | 9% | $ | |||||
| Brooks Brothers $25 | 16% | $ | Red Robin $25 | 9% | $ | |||||
| Claire's $10 (No fee card) | 9% | $ | Ruby Tuesday's $25 | 8% | $ | |||||
| Dennis Uniforms $20 | 5% | $ | P.F. Chang's $25 | 7% | $ | |||||
| $ | Dining - On The Go | |||||||||
| Express $25 | 13% | $ | Chipotle Mexican Grill $10 | 10% | $ | |||||
| Gap / Banana / Old Navy $25 | 9% | $ | Cold Stone Creamery $10 | 8% | $ | |||||
| Gymboree $25 | 13% | $ | KFC $5 | 9% | $ | |||||
| J. Crew $25 | 13% | $ | Long John Silver $5 | 8% | $ | |||||
| Lands' End $25 | **17% | $ | Panera Bread $10 | 9% | $ | |||||
| Limited $25 | 9% | $ | Papa John's $10 | 8% | $ | |||||
| Maurices $20 | 7% | $ | Pizza Hut $10 (Not accepted in AK, LA, HI) | 8% | $ | |||||
| Men's Wearhouse $25 | 8% | $ | Starbucks $10 | 7% | $ | |||||
| Payless Shoes $20 | 13% | $ | Starbucks $25 | 7% | $ | |||||
| Talbots $25 | 11% | $ | Subway $10 | 3% | $ | |||||
| The Children's Place $25 | 12% | $ | Wendy's Card $10 | 4% | $ | |||||
| TJ Maxx/Marshall's $25 | 7% | $ | Discount Store | |||||||
| Department Store | Kmart $25 | 5% | $ | |||||||
| Dillard's $25 | 9% | $ | Kmart $50 | 5% | $ | |||||
| JCPenney $25 | **7% | $ | Wal-mart/Sam's Club $25 | 2% | $ | |||||
| JCPenney $100 | **7% | $ | Wal-mart/Sam's Club $100 | 2% | $ | |||||
| Kohl's Dept. Store $25 | 4% | $ | Electronics & Office | |||||||
| Kohl's Dept. Store $100 | 4% | $ | Best Buy $25 | 2% | $ | |||||
| Macy's/Federated $25 | 10% | $ | BEST BUY $100 | 2% | $ | |||||
| Macy's/Federated $100 | 10% | $ | Office Depot $25 | 4% | $ | |||||
| Sears $25 Gift Card | 5% | $ | Office Max $25 | 5% | $ | |||||
| Dining - Casual | RadioShack $25 | 4% | $ | |||||||
| Applebee's $25 | 8% | $ | Staples $25 Gift Card | 5% | $ | |||||
| BD's Mongolian BBQ $20 | 8% | $ | Entertainment | |||||||
| Boston Market $10 | 12% | $ | AMC Theaters / Loew's Cineplex $25 | 7% | $ | |||||
| Buca di Beppo $25 | 8% | $ | Barnes & Noble/B.Dalton $10 | 9% | $ | |||||
| Chili's $25 | 11% | $ | Barnes & Noble/B.Dalton $25 | 9% | $ | |||||
| Chuck E Cheese $10 | 8% | $ | Barnes &Noble "Teacher Gift" Card $20 | 9% | $ | |||||
| Cracker Barrel $10 | 9% | $ | Blockbuster $10 | 7% | $ | |||||
| Dave & Buster's $25 | 13% | $ | Blockbuster Night Card $12.00 | 15% | $ | |||||
| Mimi's Cafe $25 | 8% | $ | Blockbuster Single Game $6 | 15% | $ | |||||
| Outback / Carrabbas $25 Card | 5% | $ | $ | |||||||
| Borders / Waldenbooks $10 | 9% | $ | ||||||||
| Borders / Waldenbooks $25 | 9% | $ | ||||||||
| Gas & Auto | Specialty Retailer | |||||||||
| Product | % | Qty | Total | Product | % | Qty | Total | |||
| BP Gas Stations $50 | 2% | $ | Sephora $20 | 4% | $ | |||||
| Shell $25 | 1.50% | $ | Toys R Us/Babies R Us $20 | 1.50% | $ | |||||
| Home Decor | Walgreens $25 | 6% | $ | |||||||
| Bed Bath & Beyond $25 | 7% | $ | Sporting Goods | |||||||
| Crate & Barrel $25 | 8% | $ | Bass Pro Shops $25 | 9% | $ | |||||
| Pier 1 $25 | 9% | $ | Cabela's $25 Card | 11% | $ | |||||
| Pottery Barn / Williams Sonoma $25 | 8% | $ | Dick's Sporting Goods $25 | 8% | $ | |||||
| Restoration Hardware $25 | 12% | $ | Sports Authority $25 | 8% | $ | |||||
| Home Improvement | Travel | |||||||||
| Home Depot $25 | 4% | $ | Disney $25 | 2% | $ | |||||
| Home Depot $100 | 4% | $ | Local | |||||||
| Lowe's $25 Gift Card | 4% | $ | HyVee $25 | 5% | $ | |||||
| LOWE'S $100 Gift Card | 4% | $ | HyVee $50 | 5% | $ | |||||
| Online & Mail Order | HyVee $100 | 5% | $ | |||||||
| Amazon.com $25 | 4% | $ | Pizza Shoppe $25 | 10% | $ | |||||
| Amazon.com $100 | 4% | $ | $ | |||||||
| HSN - Home Shopping Network $25 | 6% | $ | Write-in | |||||||
| iTunes $15 | 4% | $ | Product | % | Qty | Total | ||||
| J. Jill $25 | 8% | $ | $ | |||||||
| Omaha Steaks $25 | 9% | $ | $ | |||||||
| Shutterfly $25 card | 9% | $ | $ | |||||||
| Service | $ | |||||||||
| Regis Salons $25 | 8% | $ | $ | |||||||
| Bath & Body Works $10 | 13% | $ | $ | |||||||
| Bath & Body Works $25 | 13% | $ | $ | |||||||
| Build-A Bear Workshop $25 | 8% | $ | $ | |||||||
| CVS/pharmacy $25 | 6% | $ | $ | |||||||
| GNC $25 | 8% | $ | $ | |||||||
| Hallmark $25 Gift Card | 4% | $ | $ | |||||||
| Honey Baked Ham $10 | 12% | $ | ||||||||
| Jo Ann Fabrics $20 | 6% | $ | ||||||||
| Michaels $25 | 4% | $ | ||||||||
| PetSmart $25 | 4% | $ | ||||||||
| Rocky Mnt Choc Factory $10 | 11% | $ | ||||||||
|
Check the Great Lakes Scrip Center website (www.glscrip.com) for additional participating retailers. |
||||||||||
| Questions? Call Alicia Cook (816-746-8454) or email: acc0428@gmail.com. | ||||||||||
| ** Bonus discounts for 2008 shopping season. | ||||||||||