Scrip Order Form
St. Joseph Parish - Sylvania, Ohio
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| Other retailers available through Great Lakes Scrip www.glscrip.com |
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Scrip Order Form (St. Joseph Parish - Sylvania, Ohio) Initials: _______
| Retailers | Amount |
Scrip % |
Qty |
Total |
| $100 | 12.0% | $ | ||
| $0 | $ | |||
| 1-800-Flowers.com | $25 | 10.0% | $ | |
| Ace Hardware $ 25 | $25 | 4.0% | $ | |
| Ace Hardware $100 | $100 | 4.0% | $ | |
| Amazon.com $ 25 | $25 | 4.0% | $ | |
| Amazon.com $100 | $100 | 4.00 | $ | |
| American Airlines $ 100 | $100 | 8.0% | $ | |
| American Airlines $250 | $250 | 8.0% | $ | |
| American Eagle Outfitters | $25 | 9.0% | $ | |
| Andersons $ 25 | $25 | 4.0% | $ | |
| Andersons $100 | $100 | 4.0% | $ | |
| Angela's Hair Artistry at Definitions of Design $ 36 | $36 | 10% | $ | |
| Applebee's $ 25 | $25 | 8.0% | $ | |
| Applebee's $50 | $50 | 8.0% | $ | |
| Arby's | $10 | 8.0% | $ | |
| Art.com | $25 | 12.0% | $ | |
| AT&T 100+ Min | $9.5 | 20.0% | $ | |
| Auto Zone | $25 | 7% | $ | |
| Avis Rent A Car | $50 | 8.0% | $ | |
| Barnes & Noble $ 20 "For My Teacher" Card | $20 | 9.00% | $ | |
| Barnes & Noble Bookstores $ 10 | $10 | 9.0% | $ | |
| Barnes & Noble Bookstores $ 25 | $25 | 9.0% | $ | |
| Barnes & Noble Bookstores $100 | $100 | 9.0% | $ | |
| Barry's Bagels $ 10 | $10 | 10.0% | $ | |
| Bass Pro Shops $ 25 | $25 | 9.00% | $ | |
| Bass Pro Shops $100 | $100 | 9.0% | $ | |
| Bath & Body Works $10 (White Barn Candle Co.) | $10 | 13.0% | $ | |
| Bath & Body Works $25 (White Barn Candle Co.) | $25 | 13.0% | $ | |
| Bed Bath & Beyond | $25 | 7.0% | $ | |
| Belk Department Store | $25 | 7.0% | $ | |
| Best Buy $ 25 | $25 | 3.0% | $ | |
| Best Buy $100 | $100 | 3.0% | $ | |
| Best Western International $ 25 | $25 | 12.0% | $ | |
| Best Western International $100 | $100 | 12.0% | $ | |
| Blimpie | $5 | 8.0% | $ | |
| Blockbuster Gift Card | $10 | 7.0% | $ | |
| Blockbuster Night Card | $12 | 15.0% | $ | |
| Blockbuster Single Game | $6 | 15.0% | $ | |
| Blockbuster Single Movie Rental | $3.79 | 15.0% | $ | |
| Bloomingdale's $ 25 | $25 | 7.0% | $ | |
| Bloomingdale's $100 | $100 | 12.0% | $ | |
| Bob Evans | $10 | 10.0% | $ | |
| Borders (Waldenbooks) $10 | $10 | 9.0% | $ | |
| Borders (Waldenbooks) $25 | $25 | 9.0% | $ | |
| Boston Market | $10 | 12.0% | $ | |
| BP Gas $ 50 | $50 | 2% | $ | |
| BP Gas $100 | $100 | 2.0% | $ | |
| BP Gas $250 | $250 | 3.0% | $ | |
Column Totals |
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$ |
Scrip Order Form (St. Joseph Parish - Sylvania, Ohio) Initials: _______
| Retailers | Amount |
Scrip % |
Qty |
Total |
| Bravo $20 | $20 | 20.0% | $ | |
| Brooks Brothers | $25 | 16% | $ | |
| Buca di Beppo | $25 | 8.0% | $ | |
| Budget Car Rental | $50 | 8.0% | $ | |
| Build-A-Bear Workshop | $25 | 8.0% | $ | |
| Burger King | $10 | 4.0% | $ | |
| BW3 $25 | $25 | 20.0% | $ | |
| Cabela's $ 25 | $25 | 11.0% | $ | |
| Cabela's $100 | $100 | 11.0% | $ | |
| California Pizza Kitchen | $10 | 4.0% | $ | |
| Carnival Cruise Lines | $100 | 8.0% | $ | |
| Cascading Gift Card File Holder | $2.96 | 25% | $ | |
| Casual Male Big & Tall | $25 | 6.0% | $ | |
| Chandler Cafe | $10 | 5.0% | $ | |
| Charlie's Homemade Ice Cream and Pizza (Sylvania) | $5 | 15.0% | $ | |
| Cheesecake Factory, The | $25 | 5.0% | $ | |
| Chevron Gas $ 50 | $50 | 1.5% | $ | |
| Chevron Gas $100 | $100 | 1.5% | $ | |
| Chili's (Macaroni Grill) | $25 | 11% | $ | |
| Chipotle Mexican Grill | $10 | 10.00% | $ | |
| Chuck E. Cheese | $10 | 8.0% | $ | |
| Ciao/Real Seafood Restaurant | $25 | 20.0% | $ | |
| Circle K | $25 | 2.00% | $ | |
| Claire's (Afterthoughts, Icing) | $10 | 9.0% | $ | |
| Classic Cafe | $10 | 12.0% | $ | |
| Cold Stone Creamery | $10 | 8.0% | $ | |
| Comfort Inn Hotels $ 25 | $25 | 6.0% | $ | |
| Comfort Inn Hotels $100 | $100 | 6.0% | $ | |
| Cracker Barrel | $10 | 9.0% | $ | |
| Crate and Barrel $ 25 | $25 | 8.0% | $ | |
| Crate and Barrel $100 | $100 | 8.0% | $ | |
| CVS Pharmacy $ 25 | $25 | 6.0% | $ | |
| CVS Pharmacy $100 | $100 | 6.0% | $ | |
| Dave & Buster's | $25 | 13.0% | $ | |
| Del Taco | $10 | 4.0% | $ | |
| Dena's Designs | $25 | 5.0% | $ | |
| Denny's $10 | $10 | 7.0% | $ | |
| Dick's Sporting Goods | $25 | 8.0% | $ | |
| Dillard's $ 25 | $25 | 9.0% | $ | |
| Dillard's $100 | $100 | 9% | $ | |
| Disney Gift Card $ 25 | $25 | 2.0% | $ | |
| Disney Gift Card $100 | $100 | 2.0% | $ | |
| Disney Gift Card $1000 | $1000 | 2.0% | $ | |
| Domino's Pizza | $5 | 5.0% | $ | |
| Domino's Pizza & Coke Combo Certificate | $14 | 25.0% | $ | |
| Donato's | $10 | 10.0% | $ | |
| Dream Dinners | $75 | 8.0% | $ | |
| Dunham's Sports | $25 | 8.0% | $ | |
| Dunkin Donuts | $10 | 4.0% | $ | |
Column Totals |
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$ |
Scrip Order Form (St. Joseph Parish - Sylvania, Ohio) Initials: _______
| Retailers | Amount |
Scrip % |
Qty |
Total |
| Elder Beerman (Younker's) $ 25 | $25 | 8.0% | $ | |
| Express/Express for Men (Structure) | $25 | 13.0% | $ | |
| Exxon (Mobil) $ 50 | $50 | 1.5% | $ | |
| Exxon (Mobil) $250 | $250 | 2.0% | $ | |
| Fairmont Hotels & Resort | $100 | 12.0% | $ | |
| Family Christian Stores | $25 | 9.0% | $ | |
| Family Video $ 10 | $10 | 20.00% | $ | |
| Fashion Bug | $25 | 6.00% | $ | |
| Fazoli's | $25 | 7.0% | $ | |
| Finish Line | $25 | 10% | $ | |
| Footlocker Stores/Lady Footlocker/Kid's Footlocker | $25 | 9.0% | $ | |
| Frameworks Art & Frame $ 25 | $25 | 5.0% | $ | |
| Frameworks Art & Frame $ 50 | $50 | 5.0% | $ | |
| GameStop | $25 | 3.0% | $ | |
| Gander Mountain | $25 | 8.0% | $ | |
| GFS Marketplace $ 25 | $25 | 4.0% | $ | |
| GFS Marketplace $100 | $100 | 4.0% | $ | |
| Giant Eagle $ 25 | $25 | 4.0% | $ | |
| Giant Eagle $100 | $100 | 4.0% | $ | |
| Gift Card Wrappers (sample pack of 16) | $5.6 | 20.0% | $ | |
| GNC | $25 | 8.0% | $ | |
| Golfsmith | $25 | 8.0% | $ | |
| Great Clips | $25 | 8.0% | $ | |
| Gulf Oil | $25 | 2.0% | $ | |
| Gymboree | $25 | 13.0% | $ | |
| Hallmark Gold Crown Stores | $25 | 4.0% | $ | |
| Handel's Ice Cream | $10 | 15.0% | $ | |
| Hard Rock Cafe | $25 | 8.0% | $ | |
| Harry & David | $25 | 12% | $ | |
| Holiday Gift Card Wrappers (sample pack of 16) | $5.6 | 20.0% | $ | |
| Hollywood Video | $10 | 16.0% | $ | |
| Home Depot $ 25 (Expo Design Center) | $25 | 4.0% | $ | |
| Home Depot $100 (Expo Design Center) | $100 | 4.0% | $ | |
| Home Depot $500 (Expo Design Center) | $500 | 4.0% | $ | |
| Home Shopping Network | $25 | 8.0% | $ | |
| HoneyBaked Ham Company $ 10 | $10 | 12.0% | $ | |
| HoneyBaked Ham Company $ 50 | $50 | 12.0% | $ | |
| Hyatt Hotels $ 25 | $25 | 9.0% | $ | |
| Hyatt Hotels $100 | $100 | 9.00% | $ | |
| iTunes | $15 | 4.0% | $ | |
| J. Crew | $25 | 13.0% | $ | |
| J.Jill | $25 | 8.0% | $ | |
| JCPenney $ 25 | $25 | 5.0% | $ | |
| JCPenney $100 | $100 | 5.0% | $ | |
| Jet Black Seal Coating $ 20 | $20 | 5.0% | $ | |
| Jet Black Seal Coating $ 20 | $20 | 5.0% | $ | |
| Jet Black Seal Coating $ 50 | $50 | 5.0% | $ | |
| Jet Black Seal Coating $50 | $50 | 5.0% | $ | |
| Jimmy John's | $5 | 10.0% | $ | |
Column Totals |
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$ |
Scrip Order Form (St. Joseph Parish - Sylvania, Ohio) Initials: _______
| Retailers | Amount |
Scrip % |
Qty |
Total |
| Jo Ann Fabrics | $20 | 6.0% | $ | |
| K Mart $ 25 | $25 | 4.0% | $ | |
| K Mart $ 50 | $50 | 4.0% | $ | |
| Kay Jewelers | $50 | 6.0% | $ | |
| KFC | $5 | 9.0% | $ | |
| Kohl's $ 25 | $25 | 5.0% | $ | |
| Kohl's $100 | $100 | 5.0% | $ | |
| L.L. Bean Stores $ 25 | $25 | 15% | $ | |
| L.L. Bean Stores $100 | $100 | 15.0% | $ | |
| Lady C Clothier "Your Brighton Headquarters" $ 25 | $25 | 10.0% | $ | |
| Lady C Clothier "Your Brighton Headquarters" $100 | $100 | 10.0% | $ | |
| Landry's (Gandy Dancer/Rainforest Cafe etc.) | $25 | 9.0% | $ | |
| Lands' End $ 25 | $25 | 17.0% | $ | |
| Lands' End $100 | $100 | 17.0% | $ | |
| Learning Express Toys $ 10 | $10 | 3.0% | $ | |
| Learning Express Toys $25 | $25 | 3.0% | $ | |
| Limited | $25 | 9.0% | $ | |
| Lisa's Manicure & Pedicure Spa $ 25 | $25 | 10.0% | $ | |
| Lisa's Manicure & Pedicure Spa $100 | $100 | 10.0% | $ | |
| Little Caesars Pizza | $20 | 8.0% | $ | |
| Logan's Roadhouse | $25 | 8.0% | $ | |
| Lord & Taylor $ 25 | $25 | 8.0% | $ | |
| Lord & Taylor $100 | $100 | 8.0% | $ | |
| Lowe's Home Improvement $ 25 | $25 | 4.0% | $ | |
| Lowe's Home Improvement $ 100 | $100 | 4.0% | $ | |
| Lowe's Home Improvement $ 500 | $500 | 4.0% | $ | |
| Lowe's Home Improvement $1000 | $1000 | 4.0% | $ | |
| Macy's $ 25 (Marshall Field's) | $25 | 10.0% | $ | |
| Macy's $100 (Marshall Field's) | $100 | 10.0% | $ | |
| Mancy's Italian/Steakhouse/Shorty's Bar-B-Que/Bluewater $ 25 | $25 | 12.0% | $ | |
| Mancy's Italian/Steakhouse/Shorty's Bar-B-Que/Bluewater $100 | $100 | 12.0% | $ | |
| Marathon Gas $ 25 | $25 | 3.0% | $ | |
| Marathon Gas $100 | $100 | 3.0% | $ | |
| Marathon Gas $250 | $250 | 4.0% | $ | |
| Marco's Pizza | $10 | 20.0% | $ | |
| Marriott Hotels $ 50 (Courtyard/Fairfield/Residence Inn/MVCI etc | $50 | 8.0% | $ | |
| Marriott Hotels $100 (Courtyard/Fairfield/Residence Inn/MVCI etc | $100 | 8.0% | $ | |
| Marriott Hotels $500 (Courtyard/Fairfield/Residence Inn/MVCI etc | $500 | 8.0% | $ | |
| Max & Erma's | $20 | 13.0% | $ | |
| MC Sports | $25 | 8.0% | $ | |
| Men's Wearhouse | $25 | 8.0% | $ | |
| Menards Home Centers $ 25 | $25 | 3.0% | $ | |
| Menards Home Centers $100 | $100 | 3.0% | $ | |
| Michael's Arts and Craft Store | $25 | 4.0% | $ | |
| Mongolian BBQ | $20 | 8.0% | $ | |
| Monnette's Market | $10 | 3.0% | $ | |
| Mytee Automotive $ 25 | $25 | 5.0% | $ | |
| Mytee Automotive $100 | $100 | 5.0% | $ | |
| Ninety Nine Restaurant | $25 | 13.0% | $ | |
Column Totals |
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$ |
Scrip Order Form (St. Joseph Parish - Sylvania, Ohio) Initials: _______
| Retailers | Amount |
Scrip % |
Qty |
Total |
| Office Depot $ 25 | $25 | 4.0% | $ | |
| Office Depot $100 | $100 | 4.0% | $ | |
| Office Max | $25 | 5.0% | $ | |
| OLD NAVY (Gap/Gap Kids/Baby Gap/Banana Republic) | $25 | 9.0% | $ | |
| Olga's Kitchen | $20 | 8.0% | $ | |
| Omaha Steaks | $25 | 9.0% | $ | |
| Outback Steakhouse (Carrabba's Italian Grille) | $25 | 5.0% | $ | |
| Overstock.com | $25 | 8.0% | $ | |
| P.F. Chang's Bistro | $25 | 7.0% | $ | |
| Panera Bread $ 10 | $10 | 9.0% | $ | |
| Panera Bread $ 25 | $25 | 9.0% | $ | |
| Papa John's | $10 | 8.0% | $ | |
| Parisian | $25 | 5.0% | $ | |
| Payless Shoes | $20 | 13.0% | $ | |
| Pet Smart | $25 | 4.0% | $ | |
| Pier 1 Imports | $25 | 9.0% | $ | |
| Pizza Hut | $10 | 8.0% | $ | |
| Radio Shack | $25 | 4.0% | $ | |
| Radio Shack | $25 | 4.0% | $ | |
| Red Lobster (Olive Garden/Longhorn Steakhouse) | $25 | 9.0% | $ | |
| Red Robin | $25 | 9.0% | $ | |
| Reger's $ 10 | $10 | 10.0% | $ | |
| Reger's $ 25 | $25 | 10.0% | $ | |
| Regis Salons (BoRics) | $25 | 8.0% | $ | |
| REI Sporting Goods | $25 | 8.0% | $ | |
| Restoration Hardware $ 25 | $25 | 12.0% | $ | |
| Restoration Hardware $100 | $100 | 12.0% | $ | |
| Rite Aid | $25 | 4.0% | $ | |
| Ritz-Carlton Hotel | $50 | 8.0% | $ | |
| Ruby Tuesday's | $25 | 8.0% | $ | |
| Sally Beauty Company | $25 | 12.0% | $ | |
| Sandal's Nail Spa $ 25 | $25 | 10.0% | $ | |
| Sandal's Nail Spa $100 | $100 | 10.0% | $ | |
| Sautter's 5 Star Market $ 25 | $25 | 5.0% | $ | |
| Sautter's 5 Star Market $100 | $100 | 5.0% | $ | |
| Schoolbelles $ 25 | $25 | 5.0% | $ | |
| Scrip Wallet | $1 | 15% | $ | |
| Sears $ 25 (Great Indoors) | $25 | 4.0% | $ | |
| Sears $100 (Great Indoors) | $100 | 4.0% | $ | |
| Sears $250 (Great Indoors) | $250 | 4.0% | $ | |
| Sephora | $20 | 4.0% | $ | |
| Sephora | $20 | 4.0% | $ | |
| Shamas Urban Retreat | $50 | 15% | $ | |
| Shell Gas $ 25 | $25 | 1.5% | $ | |
| Shell Gas $ 50 | $50 | 1.5% | $ | |
| Shell Gas $100 | $100 | 1.5% | $ | |
| Shoe Carnival | $25 | 5.0% | $ | |
| Showcase Cinemas (National Amusements) | $25 | 9.0% | $ | |
| Shutterfly.com | $25 | 9.0% | $ | |
Column Totals |
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$ |
Scrip Order Form (St. Joseph Parish - Sylvania, Ohio) Initials: _______
| Retailers | Amount |
Scrip % |
Qty |
Total |
| Sofo's | $25 | 10.0% | $ | |
| Spaghetti Warehouse | $20 | 18.0% | $ | |
| Spartan Store $ 25 | $25 | 2.0% | $ | |
| Spartan Store $100 | $100 | 2.0% | $ | |
| Speedway $ 25 | $25 | 5.0% | $ | |
| Speedway $100 | $100 | 5.0% | $ | |
| Staples $ 25 | $25 | 5.0% | $ | |
| Staples $100 | $100 | 5.0% | $ | |
| Starbucks $10 | $10 | 7.0% | $ | |
| Starbucks $25 | $25 | 7.0% | $ | |
| Steak 'n Shake | $10 | 8.0% | $ | |
| Stop & Shop $ 25 | $25 | 4.0% | $ | |
| Stop & Shop $100 | $100 | 4.0% | $ | |
| Subway | $10 | 5.0% | $ | |
| Sunoco $ 50 | $50 | 1.50% | $ | |
| Sunoco $250 | $250 | 2.5% | $ | |
| Talbot's | $25 | 11.0% | $ | |
| Tanger Outlets | $25 | 8.0% | $ | |
| Texas Roadhouse | $25 | 8.0% | $ | |
| TGI Friday's $25 | $25 | 9.0% | $ | |
| The Children's Place | $25 | 12.0% | $ | |
| The Container Store | $25 | 9.0% | $ | |
| The Flower Connection $ 10 | $10 | 10.0% | $ | |
| The Flower Connection $ 25 | $25 | 10.0% | $ | |
| TJ Maxx $ 25 (HomeGoods, Marshall's) | $25 | 7.0% | $ | |
| TJ Maxx $100 (HomeGoods, Marshall's) | $100 | 7.0% | $ | |
| Toast.net $ 50 | $50 | 10% | $ | |
| Toast.net $100 | $100 | 10% | $ | |
| Tony Packo's | $25 | 14% | $ | |
| Touch of Class Dry Cleaners | $10 | 10.0% | $ | |
| Toys-R-Us (Babies-R-Us) | $20 | 1.5% | $ | |
| Twin Oak's Dry Cleaners | $10 | 10.0% | $ | |
| Uno Chicago Grill | $25 | 12% | $ | |
| UPS Store, The - Starlite Plaza Only $ 10 | $10 | 10.0% | $ | |
| UPS Store, The - Starlite Plaza Only $ 25 | $25 | 10.0% | $ | |
| Ventura's (Loma Linda's, et al) | $25 | 15.00% | $ | |
| Wal-Mart $ 25 | $25 | 2.0% | $ | |
| Wal-Mart $100 | $100 | 2.0% | $ | |
| Wal-Mart $250 | $250 | 2.0% | $ | |
| Walgreens $ 25 | $25 | 6.0% | $ | |
| Wendy's | $10 | 4.0% | $ | |
| Williams Sonoma $ 25 (Hold Everything/Pottery Barn/PB Teen/PB K | $25 | 8.0% | $ | |
| Williams Sonoma $100 (Hold Everything/)Pottery Barn/PB Teen/PB K | $100 | 8.0% | $ | |
| Zappos.com | $25 | 8.0% | $ |