Our Lady of Lourdes Catholic School In Partnership with Payment: Check: Make Check Payable to: Our Lady of Lourdes (OLL)

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1 Family Name Phone Date: / / / Our Lady of Lourdes Catholic School In Partnership with Payment: Check: Make Check Payable to: Our Lady of Lourdes (OLL) UnitedScrip Certificate Form by Category 2016 Certificate Qty Total Certificate Qty Total Advance Auto Parts 7.0% Exxon 1.0% Advance Auto Parts 7.0% Exxon 1.0% Arco Gas Stations 2.0% Jiffy Lube 9.0% Arco Gas Stations 2.0% Mobil 1.0% Arco Gas Stations 2.0% Mobil 1.0% AutoZone 9.0% Rich Gas 4.0% BP Gas Stations 1.5% Rich Gas 4.0% BP Gas Stations 1.5% Sears Auto Service Center 4.0% Chevron Gas 1.0% Sears Auto Service Center 4.0% Chevron Gas 1.0% Sears Auto Service Center 4.0% Chevron Gas 1.0% Shell Gas 2.5% Circle K 1.5% Shell Gas 2.5% Circle K 1.5% Shell Gas 2.5% Exxon 1.0% Book Stores Barnes & Noble Bookstores 9.0% Barnes & Noble College Booksellers 9.0% Barnes & Noble Bookstores 9.0% BN.com 9.0% Barnes & Noble Bookstores 9.0% BN.com 9.0% Barnes & Noble College Booksellers 9.0% Catalog/On-line Stores Baskets 14.0% Oriental Trading 9.0% Flowers.com 14.0% Overstock.com 9.0% Amazon.com 3.0% See's Candies 1 LB 17.0% Amazon.com 3.0% Shutterfly 14.0% Amazon.com 3.0% The Popcorn Factory 14.0% Amazon.com 3.0% Walmart 2.5% Amazon.com 3.0% walmart.com 2.5% Brookstone 14.0% walmart.com 2.5% Fanatics.com 9.0% 3.0% Fannie May 25.0% 3.0% fruitbouquets.com 14.0% 3.0% Groupon 7.0% 3.0% L.L. Bean 18.0% 3.0% L.L. Bean 18.0% 3.0% Lands' End 14.0% 3.0% Lands' End 14.0% 3.0% Omaha Steaks 10.0% % Omaha Steaks 10.0% Zappos.com 9.0% Children/Teen Speciality Stores American Girl 9.0% GapKids 14.0% Babies"R"Us 3.0% Gymboree 12.0% Babies"R"Us 3.0% Icing 9.0% Baby Depot 8.0% Journeys Kids 14.0% Build-A-Bear Workshop 8.0% Kid's FootLocker 9.0% buybuy BABY 6.0% Pottery Barn for Kids 8.0% buybuy BABY 6.0% Toys"R"Us 3.0% Children's Place,The 12.0% Toys"R"Us 3.0% Electronic/Technology Best Buy 3.0% itunes 5.0% Cash: Team/Family Benefitting: Orders placed Friday will be available for pick up within 5 business days (except holidays Automobile Care/Gas Cards

2 Best Buy 3.0% itunes 5.0% Health & Beauty Bath & Body Works 13.0% OutLooks for Hair 9.0% Bath & Body Works 13.0% Regis Salons 9.0% Beauty Bar 9.0% Regis Signature Salon 9.0% Carlton Hair International 9.0% Sally Beauty 14.0% Famous Hair 9.0% Sephora 5.0% Fiesta Salons 9.0% Spa & Wellness Gift Card by Spa Week 15.0% Hair by Stewarts 9.0% TGF Hair Salon 9.0% MasterCuts 9.0% Ulta Cosmetics and Salons 4.0% Home Improvement Ace Hardware 4.0% Home Depot 4.0% Ace Hardware 4.0% Lowe's Home Improvement 4.0% Home Depot 4.0% Lowe's Home Improvement 4.0% Home Depot 4.0% Lowe's Home Improvement 4.0% Home Depot 4.0% Lowe's Home Improvement 4.0% Home Depot 4.0% Lowe's Home Improvement 4.0% Hotels/Travel American Airlines 4.0% Disney Cruise Lines 3.0% American Airlines 4.0% Disneyland/Disneyworld 3.0% Avis Rental Car 6.0% Disneyland/Disneyworld 3.0% BedAndBreakfast.com 15.0% Disneyland/Disneyworld 3.0% Budget Rental Car 8.0% Disneyland/Disneyworld 3.0% Cambria Suites 4.0% Hyatt Hotels 9.0% Carnival Cruise Lines 8.0% Hyatt Hotels 9.0% Choice Hotels 4.0% Hyatt Place 9.0% Clarion Hotels 4.0% Hyatt Summerfield Suites 9.0% Comfort Inn 4.0% Mainstay Suites 4.0% Comfort Suites 4.0% Quality Inn 4.0% Delta Airlines 4.0% Six Flags 10.0% Delta Airlines 4.0% Sleep Inn 4.0% Disney Cruise Lines 3.0% Walt Disney World Resort - Florida 3.0% Disney Cruise Lines 3.0% Walt Disney World Resort - Florida 3.0% Disney Cruise Lines 3.0% Walt Disney World Resort - Florida 3.0% Movie/Entertainment Century Theatres 10.0% Regal Entertainment 8.0% Fandango.com 6.0% Regal Entertainment 8.0% GameStop 3.0% Showcase Cinema 7.0% Guitar Center 5.0% United Artist Theater 8.0% Regal Entertainment 10.0% United Artist Theater 8.0% National Grocery ACME 4.0% Safeway 4.0% ACME 4.0% Safeway 4.0% ACME 4.0% Safeway 4.0% Albertsons 4.0% SaveRite Grocery Warehouse 4.0% Albertsons 4.0% SaveRite Grocery Warehouse 4.0% Albertsons 4.0% Shop n Save 4.0% Carrs 4.0% Shop n Save 4.0% Carrs 4.0% Shop n Save 4.0% Cub 4.0% Shoppers 4.0% Cub 4.0% Shoppers 4.0% Cub 4.0% Shoppers 4.0% Farm Fresh 4.0% ShopRite 4.0% Farm Fresh 4.0% ShopRite 4.0% Farm Fresh 4.0% SuperValu 4.0% Hornbacher s 4.0% SuperValu 4.0% Hornbacher s 4.0% SuperValu 4.0% Hornbacher s 4.0% Teavana 7.0% Peapod 4.0% VONS 4.0%

3 Peapod 4.0% VONS 4.0% Peapod 4.0% Whole Foods 3.0% Safeway 4.0% Whole Foods 3.0% National Restaurants Acapulco Restaurants 9.0% Macaroni Grill 11.0% Applebee's 8.0% Macaroni Grill 11.0% Applebee's 8.0% Maggiano's Little Italy 11.0% Arby's 8.0% Maggiano's Little Italy 11.0% Arby's 8.0% McCormick & Schmick's 10.0% Bahama Breeze 9.0% McCormick & Schmick's 10.0% Bahama Breeze 9.0% Ninety Nine "99" Restaurant 13.0% Bahama Breeze 9.0% Noah's New York Bagels 10.0% Baja Fresh 7.0% Noodles Restaurants 7.0% Black Angus Steakhouse 11.0% Old Chicago 6.0% Bonefish Grill 9.0% Olive Garden 9.0% Bonefish Grill 9.0% Olive Garden 9.0% Boston Market 14.0% Olive Garden 9.0% Bubba Gump 10.0% On The Border 11.0% Bubba Gump 10.0% On The Border 11.0% Buca di Beppo 8.0% Orange Julius 3.0% Buffalo Wild Wings 8.0% Outback Steakhouse 9.0% Buffalo Wild Wings 8.0% Outback Steakhouse 9.0% Burger King 4.0% P.F. Chang's China Bistro 8.0% Burger King 4.0% Panera Bread 9.0% California Pizza Kitchen 9.0% Panera Bread 9.0% Carl's Jr 6.0% Papa John's 8.0% Carrabba's Italian Grill 9.0% Papa John's 8.0% Carrabba's Italian Grill 9.0% Peet s Coffee & Tea 12.0% Carrow's Restaurant 8.0% Pizza Hut 8.0% Cheesecake Factory 5.0% Qdoba Mexican Grill 7.0% Chili's 11.0% Quiznos 10.5% Chili's 11.0% Rainforest Cafe 10.0% Chipotle 11.0% Rainforest Cafe 10.0% Chuck E. Cheese's 8.0% Real Mex 9.0% Claim Jumper 10.0% Red Lobster 9.0% Claim Jumper 10.0% Red Lobster 9.0% Cold Stone Creamery 8.0% Red Lobster 9.0% Cracker Barrel Old Country Store 9.0% Red Robin 9.0% Cracker Barrel Old Country Store 9.0% Red Robin 9.0% Dairy Queen 3.0% Red Sushi 10.0% Dave & Buster's 14.0% Red Sushi 10.0% Del Taco 8.0% Restaurant.com 50.0% Denny's 7.0% Rock Bottom Restaurants 6.0% Domino's 8.0% Ruby Tuesday 8.0% Domino's 8.0% Ruby Tuesday 8.0% Dunkin Donuts 3.0% Ruth s Chris Steak House 9.0% Dunkin Donuts 3.0% Ruth s Chris Steak House 9.0% Einstein Bros. Bagels 10.0% Souplantation 9.0% Fisherman's Wharf 10.0% Starbucks 7.0% Fisherman's Wharf 10.0% Starbucks 7.0% Fleming's 9.0% Starbucks 7.0% Fleming's 9.0% Subway 3.0% Fuddruckers 8.0% Subway 3.0% Golden Corral 8.0% Taco Bell 4.0% Great Harvest Bread Co 6.0% TGI Friday's 9.0% Hard Rock Cafe 9.0% TGI Friday's 9.0% HoneyBaked Ham 15.0% The Crab House 10.0% IHOP 8.0% The Crab House 10.0% Jack in the Box 4.0% The Oceanaire 10.0%

4 Krispy Kreme 8.0% The Oceanaire 10.0% Krispy Kreme 8.0% Tower of the Americas 10.0% Landry's Gift Card 10.0% Tower of the Americas 10.0% Landry's Gift Card 10.0% Walnut Brewery (Rock Bottom) 6.0% Landry's Seafood House 10.0% Wendy's 4.0% Landry's Seafood House 10.0% WhoSong&Larry's 9.0% Little Caesars 8.0% National Retailers A Pea in the Pod 10.0% Michaels 4.0% Aerie 6.0% Motherhood Maternity Outlet 10.0% Aeropostale 15.0% Nike Gift Card 13.0% American Eagle Outfitters 6.0% Nike Women Stores 13.0% American Express Business Gift Card 1.5% NIKETOWN 13.0% American Express Business Gift Card 1.5% Old Navy 14.0% American Express Business Gift Card 1.5% P.S. by Aeropostale 15.0% Athleta 14.0% Payless ShoeSource 13.0% Banana Republic 14.0% Petco 5.0% Bass Pro Shops 9.0% PetSmart 4.0% Bass Pro Shops 9.0% Pier 1 Imports 9.0% Bed Bath & Beyond 6.0% Pottery Barn 8.0% Bed Bath & Beyond 6.0% Pottery Barn 8.0% Big 5 Sporting Goods 8.0% REI Stores 8.0% Bloomingdales 7.0% Rocky Mountain Chocolate Factory 12.0% Brooks Brothers 14.0% ROSS Dress For Less 9.0% Burlington Coat Factory 8.0% Russell Stover/Whitman Candies 9.0% Cabela's 11.0% Sam's Club 2.5% Cabela's 11.0% Sam's Club 2.5% Claire's 9.0% Sears 4.0% Columbia 14.0% Sears 4.0% Crate and Barrel 5.0% Sears 4.0% Dennis Uniform 5.0% ShopKo 3.0% Destination Maternity 10.0% Sunglass Hut 9.0% Dick's Sporting Goods 5.0% T.J. Maxx 7.0% Dillard's 9.0% T.J. Maxx 7.0% Disney Stores 3.0% Talbots 9.0% Disney Stores 3.0% Tanger Outlet Stores 9.0% Disney Stores 3.0% Target 2.5% Disney Stores 3.0% Target 2.5% Express 11.0% Target 2.5% Express for Men 11.0% Target 2.5% Foot Locker 9.0% Target 2.5% Gap Tri-Card 14.0% Target 2.5% Gap Tri-Card 14.0% The Container Store 9.0% Hallmark 4.0% Under Armour 12.0% HomeGoods 7.0% Universal Orlando $25.00 J. Crew 12.0% Visa 1.5% JCPenney 5.0% Walmart 2.5% JCPenney 5.0% Walmart 2.5% Jo-Ann Stores 6.0% Walmart 2.5% Journeys 14.0% Walmart 2.5% Kmart 4.0% Walmart 2.5% Kohl's 4.0% Walmart 2.5% Kohl's 4.0% Walmart 2.5% Lane Bryant 7.0% West Elm 8.0% Lord & Taylor 5.0% West Elm 8.0% Macy's 10.0% Williams-Sonoma 8.0% Macy's 10.0% Williams-Sonoma 8.0% Marshalls 7.0% Yankee Candle 8.0% Men's Wearhouse 7.0%

5 Office Supplies Office Depot 4.0% Staples 5.0% Office Max 4.0% Staples 5.0% Pharmacy/Drug Stores CVS 4.0% Sav-on Drug 4.0% CVS 4.0% Sav-on Drug 4.0% Rite Aid 4.0% Walgreens 6.0% Rite Aid 4.0% Walgreens 6.0% Scrip Accessories Envelopes 'Birthday Party' 20.0% Gift Box - Gold Swirls 20.0% Envelopes 'Gift Tree' 20.0% Gift Box - Lavender Lane 20.0% Envelopes 'New Baby' 20.0% Gift Box - Lovely Leaf 20.0% Envelopes 'Thank You' 20.0% Gift Box - Red Chevron 20.0% Gift Box - Black Chevron 20.0% Gift Box - Sailor Stripe 20.0% Gift Box - Black/White Damask 20.0% Gift Box - Wedding Bells 20.0% Gift Box - Cheerful Stripe 20.0% Saks Fifth Avenue 12.0% Gift Box - Diamond Dots 20.0% Victoria Secret 6.0% Gift Box - Fun Dots 20.0% Comments/Notes/Special Instructions: Grand Total: $ We can not be responsible for lost or stolen Gift Cards. Please sign below in the appropriate box to indicate your preference for delivery. Send Home with Child: Pick Up in Office: X X

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