Nathan Hale PTO Scrip Order Form
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1 Nathan Hale PTO Scrip Order Form Name: Phone # Student/Grade: GROCERY: Merchant Profit $ Qty Total Walmart / Sam's Club 3% $10.00 Walmart / Sam's Club 3% $25.00 Walmart / Sam's Club 3% $50.00 Walmart / Sam's Club 3% $ Walmart / Sam's Club 3% $ Target 3% $5.00 Target 3% $10.00 Target 3% $25.00 Target 3% $50.00 Target 3% $ ShopRite 4% $25.00 ShopRite 4% $ Stop & Shop / Peapod Online Grocery 4% $25.00 Stop & Shop / Peapod Online Grocery 4% $ Whole Foods Market 3% $25.00 Whole Foods Market 3% $ GAS & AUTO: Advance Auto Parts 5% $25.00 Amoco/BP Gasoline 1% $50.00 Amoco/BP Gasoline 1% $ Amoco/BP Gasoline 1% $ Auto Zone 6% $25.00 Chevron Gasoline/Texaco Gasoline 1% $50.00 Chevron Gasoline/Texaco Gasoline 1% $ Chevron Gasoline/Texaco Gasoline 1% $ Exxon/Mobil 1% $10.00 Exxon/Mobil 1% $50.00 Exxon/Mobil 1% $ Exxon/Mobil 1% $ Gulf Oil 2% $50.00 Jiffy Lube 8% $30.00 Kmart/Sears 4% $25.00 Kmart/Sears 4% $ Shell 3% $10.00 Shell 3% $20.00 Page 1 of 6
2 Shell 3% $25.00 Shell 3% $50.00 Shell 3% $ Sunoco Gasoline 1% $50.00 Sunoco Gasoline 1% $ Sunoco Gasoline 1% $ RESTAURANTS: 99 Restaurants 13% $25.00 Applebee's 10% $25.00 Arby's 9% $10.00 Boston Market 14% $25.00 Brueggers Bagels 7% $10.00 Buffalo Wild Wings 8% $25.00 Burger King 4% $10.00 Carrabba's Italian Grill 8% $25.00 Carrabba's Italian Grill 8% $ Cheesecake Factory 5% $25.00 Chili's/On the Border 11% $25.00 Cold Stone Creamery 8% $5.00 Cold Stone Creamery 8% $10.00 Cracker Barrel 9% $10.00 Cracker Barrel 9% $25.00 Dairy Queen 3% $ Domino's Pizza 8% $10.00 Dunkin' Donuts 3% $10.00 HomeTowne Buffet 5% $25.00 IHOP 8% $25.00 KFC 9% $5.00 LongHorn Steakhouse /Olive Garden /Red Lobster 9% $25.00 LongHorn Steakhouse /Olive Garden /Red Lobster 9% $ Mrs. Field's 10% $5.00 Panera Bread 9% $10.00 Panera Bread 9% $25.00 Pizza Hut 8% $5.00 Pizza Hut 8% $10.00 Ruby Tuesday 8% $25.00 SUBWAY 3% $5.00 SUBWAY 3% $10.00 SUBWAY 3% $50.00 Starbucks Coffee 6% $5.00 Starbucks Coffee 6% $10.00 Starbucks Coffee 6% $25.00 Page 2 of 6
3 TGI Friday's 9% $25.00 Taco Bell 2% $10.00 Texas Roadhouse 8% $25.00 Wendy's 4% $10.00 RETAIL: 1800flowers.com 13% $25.00 Aerie/American Eagle Outfitters 10% $25.00 Aeropostale 7% $25.00 Amazon.com 3% $10.00 Amazon.com 3% $25.00 Amazon.com 3% $ American Girl 9% $25.00 American Girl 9% $50.00 BabiesЯUs/ToysЯUs 3% $25.00 BabiesЯUs/ToysЯUs 3% $ Baby Depot/Burlington Coat Factory 8% $25.00 Banana Republic/Gap/Old Navy 14% $25.00 Barnes & Noble 9% $5.00 Barnes & Noble 9% $10.00 Barnes & Noble 9% $25.00 Barnes & Noble 9% $ Bath & Body Works 14% $5.00 Bath & Body Works 14% $ Bath & Body Works 14% $25.00 Bed Bath and Beyond/Buy Buy Baby/Christmas Tree Shops/Harmon Face Values Bed Bath and Beyond/Buy Buy Baby/Christmas Tree Shops/Harmon Face Values 5% $ % $ Best Buy 3% $25.00 Best Buy 3% $ Best Buy 3% $ Bon Ton 8% $25.00 Brookstone 14% $25.00 Brookstone 14% $ Build A Bear Workshop 8% $25.00 CVS 4% $25.00 CVS 4% $ Cabela's 11% $25.00 Cabela's 11% $ Cacique/Catherine's/Lane Bryant 7% $25.00 Champs Sports Store/Foot Locker/FootAction USA/Kids Foot Locker/Lady Foot Locker 6% $25.00 Children's Place 12% $25.00 Page 3 of 6
4 Claire's/Icing by Claire's 9% $10.00 Crate & Barrel 6% $25.00 Crate & Barrel 6% $50.00 Dick's Sporting Goods 4% $25.00 Dick's Sporting Goods 4% $ Disney Resorts/Disney Store 2% $25.00 Disney Resorts/Disney Store 2% $ Disney Resorts/Disney Store 2% $ Disney Resorts/Disney Store 2% $1, EB Games/GameStop 3% $25.00 EXPRESS 10% $25.00 Finish Line 10% $25.00 Gymboree 13% $25.00 Hallmark 4% $25.00 Home Depot 3% $25.00 Home Depot 3% $ Home Depot 3% $ Home Depot 3% $2, HomeGoods/Marshalls/T.J. Maxx 7% $25.00 HoneyBaked Ham 13% $25.00 JCPenney 5% $25.00 JCPenney 5% $ Jo Ann Fabric & Craft Stores 6% $25.00 Kohl's 4% $10.00 Kohl's 4% $25.00 Kohl's 4% $50.00 Kohl's 4% $ L.L. Bean 17% $25.00 L.L. Bean 17% $ Lands' End 15% $25.00 Lands' End 15% $ Lids 8% $25.00 Lord & Taylor 4% $25.00 Lowe's Home Improvement 4% $25.00 Lowe's Home Improvement 4% $ Page 4 of 6
5 Lowe's Home Improvement 4% $ Lowe's Home Improvement 4% $1, Lowe's Home Improvement 4% $2, Macy's 10% $25.00 Macy's 10% $50.00 Macy's 10% $ Men's Wearhouse 7% $25.00 Michaels 4% $25.00 Nike 12% $25.00 PB Teen/Pottery Barn/Pottery Barn Kids 7% $25.00 PB Teen/Pottery Barn/Pottery Barn Kids 7% $ Payless ShoeSource 9% $20.00 PetSmart 4% $25.00 Pier 1 imports 10% $25.00 Sally's Beauty Supply 13% $25.00 Sephora 4% $20.00 Shutterfly 9% $25.00 Sports Authority 7% $25.00 Staples 5% $25.00 Staples 5% $ Talbots 9% $25.00 Walgreens 3% $25.00 Walgreens 3% $ Williams Sonoma/Williams Sonoma Home 7% $25.00 Williams Sonoma/Williams Sonoma Home 7% $ Yankee Candle 8% $25.00 Dressbarn 9% $25.00 itunes 4% $15.00 itunes 4% $25.00 *** PLEASE NOTE Additional Gift Card options, including Travel/lodging, are available at under merchants. Please add any additional Gift card choices on the lines below. Total Order Page 5 of 6
6 Please submit completed order forms with full payment to the school office in a sealed envelope. Please label GIFT CARD FUNDRAISER ATTENTION MR. VOISINE PLEASE NOTE CASH OR BANK CHECKS ONLY (personal checks and debit/credit cards will not be accepted) ORDER SCHEDULE Orders received by 11/26/14 will be ready for pick up by 12/5/14 Orders received by 12/5/14 will be ready for pick up by 12/12/14 Orders received by 12/12/14 will be ready for pick up by 12/19/14 Additional order dates will be provided in January 2015 Order inquiries & questions can be directed to: Mary Kelleher mkelleher71@yahoo.com Page 6 of 6
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