Immaculate Conception School SCRIP Order Form
Orders Due Every Thursday Morning by 10am!
Thank you very much for supporting Immaculate Conception School!
PLEASE MAKE CHECKS PAYABLE TO IMMACULATE CONCEPTION SCHOOL
Parent/Purchaser Name
RETURN CHECK FEE: $25.00
Phone # to call incase of problem
Student Name, Grade & Class
Date of Order
Initial for Pickup at the Office
Initial for Wednesday Folder Delivery
Check # and Amount
RETAILERS ALPHABETICALLY
& Percentage Earned by IC
Ace Hardware 4%
DENOM
Amazon.com 4%
American Eagle Outfitters 10%
Applebee’s 8%
AT&T 120 Minute Card 20%
Barnes & Noble Teacher Gift Card 9%
$25/$100
$25
$25/$50
$9.50
$20
Barnes & Noble/B. Dalton 9%
Baskin Robbins 9%
Bass Pro Shops 9%
Bath & Body Works/White Barn Candle
Company 13%
Bed Bath & Beyond 7%
Best Buy 3%
Blockbuster 7%
Bon-Ton 8%
Borders/Waldenbooks 9%
Brueggers Bagels 7%
Build-A-Bear Workshop 8%
Burger King 4%
Cascading Card File (holds 10 Cards) 25%
Claire’s 9%
Chili’s 9%
Chuck E Cheese 8%
Cold Stone Creamery 8%
Cracker Barrel 9%
Crate & Barrel 8%
CVS Pharmacy 6%
Denny’s 7%
Disney Gift Card 2%
Domino’s Pizza 8%
$10/$25
$2
$25/$100
$10/$25
$25/$100
$25
$25/$100
$10
$25/$100
$10/$25
$10
$25
$10
$2.96
$10
$25
$10
$10
$10
$25/$100
$25/$100
$10
$25/$100
$5
QTY
Total $
RETAILERS ALPHABETICALLY
& Percentage Earned by IC
Dunkin Donuts 4%
DENOM
Eddie Bauer 10%
Express 13%
Exxon/Mobile (All States) 1.5%/2%
Fashion Bug/Lane Bryant 6%
Gamestop/EB Games/Electronics
Boutique 3%
Gander Mountain 8%
Gap/Banana Republic/Old Navy 9%
Gift Card Wrapper - 16 pack 20%
Gymboree 13%
$25
$25
$50/$250
$25
$25
Harry and David 10%
Home Depot 4%
Honey Baked Ham 12%
ITunes 4%
JCPenney 5%
Jo-Ann Fabrics 6%
KFC 9%
Kmart 4%
Kohl’s Department Store 4%
Land’s End 16%
Limited 9%
LL Bean 15%
Lord & Taylor 8%
Lowe’s Home Improvement 4%
Macy’s 10%
Michael’s 4%
$25
$25/$100
$10
$15
$25/$100
$20
$5
$25/$50
$25/$100
$25/$100
$25
$25/$100
$25
$25/$100
$25/$100
$25
TOTAL PAGES ONE
$10
$25
$25
$5.60
$25
QTY
Total $
Retailers Alphabetically
& Percentage Earned by IC
DENOM
QTY
Office Depot 4%
Office Max 5%
Old Country Buffet 5%
Outback/Carrabbas/Bonefish Grill 8%
Panera Bread 9%
Papa John’s 8%
Pier 1 Imports 9%
Pizza Hut 8%
RadioShack 4%
Red Lobster/Olive Garden 9%
Red Robin 9%
Regal Entertainment (UA Theater) 8%
Regis Salons/Trade Secret 8%
Rite Aid 4%
Sally Beauty Supply 12%
Sears 4%
Sephora 4%
Shell 2.5%
Shutterfly 9%
Spaghetti Warehouse 18%
Sports Authority 8%
Staples 5%
Starbuck’s 7%
Subway 3%
Sunoco 1.5%/2%
Talbot’s 13%
Texas Roadhouse 8%
TGI Friday’s 9%
TJ Maxx/Marshall’s 7%
Tim Hortons 5%
Toys R Us/Babies R Us 1.5%
Wal Mart/Sam’s Club 2%
Walgreens 6%
Wendy’s 4%
$25/$100
$25
$25
$25
$10
$10
$25
$10
$25
$25
$25
$25
$25
$25
$25
$25/$100
$20
$25/$100
$25
$20
$25/$100
$25/$100
$10/$25
$10/$50
$50/$250
$25
$25
$25
$25/$100
$10
$20
$25/$100
$25/$100
$10
TY
Williams Sonoma/Pottery Barn 8%
$25/$100
TOTAL $
RETAILERS Alphabetically
& Percentage Earned by IC
Write in Extra Retailers not on Form!
Thank You!
INS
DENOM
QTY
QTY
TOTAL PAGE TWO
OVERALL TOTAL FOR BOTH SIDES
TOTAL $