| SCRIP ORDER FORM | |||||||||
| Name:_________________________________Date:____________ | |||||||||
| Northview Baptist Academy | |||||||||
| Phone:__________________Check#:_________Amount:_______ | Contacts | ||||||||
| Contact info: Tina Bryant | |||||||||
| Teacher:_______________________________________________ | Phone: 488-4748 | ||||||||
| Email: bryant4242@embarqmail.com | |||||||||
| Item | Description | Qty | Price | Total | Item | Description | Qty | Price | Total |
| National Grocery | |||||||||
| 1161 | HEB/Central Market $25 (2%) | $25.00 | 1157 | Shaw's $50 (4%) | $50.00 | ||||
| 1156 | Shaw's $25 (4%) | $25.00 | 1183 | Albertson-Jewel-Osco $50 (4%) | $50.00 | ||||
| 1040 | Giant Eagle $50 (4%) | $50.00 | 1151 | Safeway $25 (4%) | $25.00 | ||||
| 1145 | ShopKo $25 | $25.00 | 1171 | Stater Bros. $25 (5%) | $25.00 | ||||
| 1011 | Stop & Shop $25 (Giant, Super G, Tops, Martins) | $25.00 | 1114 | WinnDixie $50 (4%) | $50.00 | ||||
| 1148 | ShopRite $25 4% | $25.00 | 1153 | Safeway $100 (4%) | $100.00 | ||||
| 1013 | Stop & Shop $100 (4%) | $100.00 | |||||||
| National Restaurants | |||||||||
| 230 | Buca di Beppo $25 (8%) | $25.00 | 323 | Dream Dinners $75 (8%) | $75.00 | ||||
| 492 | Tully's Coffee $10 (9%) | $10.00 | 214 | Applebee's $25 (8%) | $25.00 | ||||
| 211 | Applebee's $10 (8%) | $10.00 | 216 | Baskin-Robbins $2 (8%) | $2.00 | ||||
| 250 | Black Angus Steakhouse $25 (11%) | $25.00 | 234 | Bob Evans $20 (12%) | $20.00 | ||||
| 226 | Boston Market $10 (12%) | $10.00 | 232 | Bruster's Ice Cream $5 (8%) | $5.00 | ||||
| 233 | Burger King $10 (4%) | $10.00 | 316 | California Pizza Kitchen $10 (4%) | $10.00 | ||||
| 241 | Carrows $10 (8%) | $10.00 | 300 | Cheesecake Factory $25 (3%) | $25.00 | ||||
| 302 | Chili's $10 (11%) | $10.00 | 303 | Chili's $25 (11%) | $25.00 | ||||
| 311 | Chuck E. Cheese $10 (8%) | $10.00 | 318 | Claim Jumper $25 (8%) | $25.00 | ||||
| 296 | Cold Stone Creamery $10 (8%) | $10.00 | 282 | Cracker Barrel $10 (9%) | $10.00 | ||||
| 283 | Cracker Barrel $25 (9%) | $25.00 | 319 | Del Taco Gift Certificates $5 (5.5%) | $5.00 | ||||
| 325 | Denny's $10 (7%) | $10.00 | 670 | Domino's $5 (4%) Paper | $5.00 | ||||
| 324 | Dunkin Donuts $10 (4%) | $10.00 | 374 | Friendly's $25 (7%) | $25.00 | ||||
| 350 | Golden Corral $25 NEW DENOMINATION | $25.00 | 328 | Great Harvest Bread Company $10 (8%) | $10.00 | ||||
| 395 | HoneyBaked Ham $25 (15%) | $25.00 | 381 | KFC $5 (9%) | $5.00 | ||||
| 383 | Landry's $20 (8%) | $20.00 | 385 | Logan's RoadHouse $25 (8%) | $25.00 | ||||
| 384 | Long John Silver's $5 (9%) | $5.00 | 388 | Longhorn Steakhouse $25 (11%) | $25.00 | ||||
| 397 | Marie Callender's $25 (13%) | $25.00 | 387 | Mimi's Cafe $10 (8%) | $10.00 | ||||
| 403 | Ninety Nine '99' Restaurant (13%) | $25.00 | 405 | Noodles Restaurants $25 Gift Card (4%) | $25.00 | ||||
| 401 | O'Charley's $10 (13%) | $10.00 | 402 | O'Charley's $25 (13%) | $25.00 | ||||
| 404 | Old Country Buffet $25 8% | $25.00 | 342 | OliveGarden/RedLobster/SmokeyBones/BahamaBreeze $10 (9%) | $10.00 | ||||
| 343 | OliveGarden/RedLobster/SmokeyBones/BahamaBreeze $25 (9%) | $25.00 | 408 | OutBack/Carrabba's Italian Grill $25 (4%) | $25.00 | ||||
| 418 | P.F. Chang's China Bistro $25 (7%) | $25.00 | 820 | Panera Bread $10 (9%) | $10.00 | ||||
| 411 | PaPa John's Pizza $10 (6%) | $10.00 | 412 | Pizza Hut $10 (8%) | $10.00 | ||||
| 450 | Red Robin $10 (7%) | $10.00 | 462 | Ruby Tuesday $10 (8%) | $10.00 | ||||
| 463 | Ruby Tuesday's $25 (8%) | $25.00 | 502 | Ryan's/Fire Mountain $10 (8%) | $10.00 | ||||
| 482 | Spaghetti Warehouse $25 (18%) | $25.00 | 531 | Starbucks $10 (7%) | $10.00 | ||||
| 532 | Starbucks $25 (7%) | $25.00 | 536 | Subway $10 (3%) | $10.00 | ||||
| 840 | TCBY $5 (12%) | $5.00 | 485 | Texas RoadHouse $10 (8%) | $10.00 | ||||
| 506 | TGIFriday's $10 (8%) | $10.00 | 512 | Wendy's $10 (4%) | $10.00 | ||||
| 223 | Bennigan's $25 (13%) | $25.00 | 452 | El Torito/Acapulco $25 (9%) | $25.00 | ||||
| 488 | Taco Cabana $10 (6%) | $10.00 | |||||||
| National Retailers | |||||||||
| 619 | American Eagle $25 (8%) | $25.00 | 633 | Bass Pro Shops $25 (8%) | $25.00 | ||||
| 621 | Bath & Body Works $10 (13%) | $10.00 | 622 | Bath & Body Works $25 (13%) | $25.00 | ||||
| 634 | Bed, Bath and Beyond $25 (6%) | $25.00 | 635 | Belk's $25 (10%) | $25.00 | ||||
| 658 | Brunswick Zone $10 (12%) | $10.00 | 654 | Claire's $10 (9%) | $10.00 | ||||
| 668 | Dick's Sporting Goods $25 (5%) | $25.00 | 667 | Dillard's $25 (8%) | $25.00 | ||||
| 673 | Disney Gift Card $25 (2%) | $25.00 | 681 | Eddie Bauer $25 (7%) | $25.00 | ||||
| 684 | Express $20 (12%) | $20.00 | 690 | Family Christian $25 (9%) | $25.00 | ||||
| 686 | Footlocker $25 (9%) | $25.00 | 694 | GameStop $25 (3%) | $25.00 | ||||
| 691 | Gap, Old Navy, Banana Republic $25 (9%) | $25.00 | 688 | Goody's $25 (5%) | $25.00 | ||||
| 693 | Gordmans $25 (7%) | $25.00 | 722 | JCPenney $25 (5%) | $25.00 | ||||
| 724 | JCPenneys $100 (5%) | $100.00 | 731 | Jo-Ann Fabrics $20 (6%) | $20.00 | ||||
| 762 | Kmart $25 (4%) | $25.00 | 745 | Kohl's Department Store $25 (4%) | $25.00 | ||||
| 778 | Linens 'n Things $25 (8%) | $25.00 | 790 | Lord & Taylor $25 (8%) | $25.00 | ||||
| 829 | Macy's $25 (9%) | $25.00 | 805 | Men's WearHouse $25 (7%) | $25.00 | ||||
| 796 | Nike $50 (8%) | $50.00 | 823 | Payless Shoes $10 (13%) | $10.00 | ||||
| 825 | Pier1 $25 (8%) | $25.00 | 824 | ROSS Dress For Less $25 (9%) | $25.00 | ||||
| 850 | Sally Beauty $25 (14%) | $25.00 | 833 | Sears $100 (4%) | $100.00 | ||||
| 830 | Sears $25 (4%) | $25.00 | 828 | Shoe Carnival $25 (4%) | $25.00 | ||||
| 8262 | Sport's Authority $25 (8%) | $25.00 | 842 | Sunglass Hut $25 (9%) | $25.00 | ||||
| 8525 | Talbots Gift Card $25 (9%) | $25.00 | 851 | Tanger Outlet Stores $25 (9%) | $25.00 | ||||
| 807 | TJMaxx/ Marshalls/ HomeGoods/ A.J. Wright $25 (7%) | $25.00 | 997 | Williams & Sonoma $25 (8%) | $25.00 | ||||
| 674 | Disney Gift Card $100 (2%) | $100.00 | 832 | Sears $250 (4%) | $250.00 | ||||
| 844 | Timberland $25 (15%) Limited Number Available | $25.00 | |||||||
| Childrens Speciality Stores | |||||||||
| 660 | Build-A-Bear Workshop $25 (8%) | $25.00 | 741 | K B Toys $10 (9%) | $10.00 | ||||
| 8472 | Toys R Us $25 (1.5%) | $25.00 | 846 | ToysRUs $10 (1.5%) | $10.00 | ||||
| Movie/Entertainment | |||||||||
| 661 | Blockbuster $10 (8%) | $10.00 | 669 | Blockbuster Game Card ($8 value) $7 (27%) | $7.00 | ||||
| Electronic/Technology | |||||||||
| 638 | Best Buy $25 (2%) | $25.00 | 653 | Circuit City $50 (2%) | $50.00 | ||||
| 821 | Ritz Camera $25 (6%) | $25.00 | 809 | Total Access Phone Cards $20 (15%) | $20.00 | ||||
| Office Supplies | |||||||||
| 810 | Office Depot $25 (3%) | $25.00 | 811 | Office Max $25 (3%) | $25.00 | ||||
| 839 | Staples $25 (5%) | $25.00 | |||||||
| Catalog and On-line Stores | |||||||||
| 712 | iTunes $25 (3%) | $25.00 | 400 | Omaha Steaks $50 (10%) | $50.00 | ||||
| 483 | See's Candies 1 lb $14.50(25%) | $14.50 | 8451 | TicketMaster $25 (4%) | $25.00 | ||||
| 613 | Amazon $50 (5%) | $50.00 | 612 | Amazon.com $25 (5%) | $25.00 | ||||
| 623 | Art.com $25 (8%) | $25.00 | 647 | Cabela's $25 (8%) | $25.00 | ||||
| 692 | Gevalia Gift Cards $20 (10%) | $20.00 | 776 | L.L.Bean $25.00 (16%) | $25.00 | ||||
| 768 | Land's End $25 (9%) | $25.00 | 800 | Lillian Vernon $15 (12%) Paper | $15.00 | ||||
| 398 | Omaha Steaks $25 (10%) | $25.00 | 802 | Orvis Retail&Catalog/On-line $25 (15%) | $25.00 | ||||
| 819 | Pro Golf $25 (10%) | $25.00 | 827 | Shutterfly $25 (8%) | $25.00 | ||||
| Pharmacy/Drug Stores | |||||||||
| 657 | CVS Gift Card $25 (2%) | $25.00 | 935 | Walgreens Gift Card $25 (2%) | $25.00 | ||||
| Book Stores | |||||||||
| 626 | Barnes & Noble $10 (9%) | $10.00 | 627 | Barnes & Noble $25 (9%) | $25.00 | ||||
| 659 | Books-A-Million $15(8%) | $15.00 | 981 | Borders Books $10 9% | $10.00 | ||||
| Home Improvement | |||||||||
| 706 | Home Depot $500 (3%) Requires 1 week | $500.00 | 702 | Home Depot $25 (3%) | $25.00 | ||||
| 703 | Home Depot $50 (3%) | $50.00 | 782 | Lowe's $25 (4%) | $25.00 | ||||
| 783 | Lowe's $50 (4%) | $50.00 | 786 | Lowe's $500 (4%) Requires 1 week | $500.00 | ||||
| 784 | Lowe's $100 (4%) | $100.00 | |||||||
| Hotels and Travel | |||||||||
| 999 | Carnival Cruise Lines $100 (8%) | $100.00 | 1020 | Hyatt Hotels $25 (8%) | $25.00 | ||||
| 1003 | Marriott $100 (12%) | $100.00 | 1002 | Marriott $50 (12%) | $50.00 | ||||
| Automobile Care/Gas Cards | |||||||||
| 931 | Advance Auto Parts $25 (7%) | $25.00 | 941 | Arco Gas Card $50 (2%) | $50.00 | ||||
| 962 | BP and ARCO $50 (1.5%) | $50.00 | 901 | Chevron Gas $50 (1.5%) | $50.00 | ||||
| 952 | Exxon/Mobil Gas Cards $50 (2%) | $50.00 | 960 | Holiday Stationstores $25 (2.5%) | $25.00 | ||||
| 976 | Shell Gas Card $25 (1.5%) | $25.00 | 978 | Shell Gas Card $50 (1.5%) | $50.00 | ||||
| 989 | Speedway Gas Card $50 (4%) | $50.00 | 969 | Sunoco Gas Cards $50 (1.5%) | $50.00 | ||||
| 953 | Exxon/Mobil $100 (2%) | $100.00 | 977 | Shell Card $100 (1.5%) | $100.00 | ||||
| TOTAL A: | TOTAL B: | ||||||||
| GRAND TOTAL (TOTAL A+ TOTAL B): | |||||||||
| Note : Orders are due by 9 am on Tuesday. Any orders received after this time will be filled the following week. Orders will be available for pick-up in the office by Thursday afternoon, | |||||||||