| St. Monica Scrip Order Form | School Family Name: | |||||||||||
| (Revised 10/17/07) | Name: | Date: | ||||||||||
| Home Phone | Sold by | |||||||||||
| Scrip Sale Days: Monday, Wednesday, Friday 8:15 - 9:15 | ||||||||||||
| ITEMS REGULARLY IN STOCK | ||||||||||||
| √ or | √ or | |||||||||||
| Groceries | % | $ | QTY | Total $ | Need | Coffee Houses | % | $ | QTY | Total $ | Need | |
| Albertsons | 4% | $ 25 | Starbucks Card | 7% | $10 | |||||||
| $100 | $25 | |||||||||||
| PCC | $ 50 | Tully's | 10% | $10 | ||||||||
| QFC / Fred Meyer | 5% | $ 50 | $25 | |||||||||
| $100 | √ or | |||||||||||
| Safeway | 4% | $ 25 | Juice Bars | % | $ | QTY | Total $ | Need | ||||
| $100 | Emerald City Smoothie | 10% | $20 | |||||||||
| √ or | Jamba Juice | 7% | $10 | |||||||||
| Automotive | % | $ | QTY | Total $ | Need | √ or | ||||||
| Shell | 1.5% | $ 25 | Restaurants | % | $ | QTY | Total $ | Need | ||||
| $100 | Baskin & Robbins | 9% | $ 2 | |||||||||
| Chevron | 1.5% | $ 50 | Burger King | 4% | $10 | |||||||
| √ or | California Pizza Kitchen | 4% | $10 | |||||||||
| Books | % | $ | QTY | Total $ | Need | Chili's / Maggiano's | 11% | $25 | ||||
| Amazon.com | 7% | $ 25 | Dominos Pizza | 5% | $ 5 | |||||||