St. Robert "SCRIP" Order Form

Instructions:

  • Fill out all appropriate fields.
  • All fields in 'Red' are required fields and must be completed.
  • After all requests have been entered, either select the 'SUBMIT Scrip Order' button at the bottom of this form (the fields entered will be E-Mailed to the St. Robert's Scrip Coordinator). Also, please be sure to have your payment (Check or Cash) ready at time of scrip pick up.
    - - OR - -
    Print out the completed form and send it to the Rectory. Please enclose payment with your order form.
  • Scrip orders will be available on Wednesday afternoons for pickup at the Rectory or delivery via school & your child.
  • For pickup at Rectory: payment can be made at time of order, or time of pickup.
  • For delivery via the School through your child: payment must be made with the order form.
For a greater selection of cards, go to: ShopWithScrip.com

Saint Robert's School ID# / Enrollment Code: DA81751D9953
 (this code is case sensitive and must be entered exactly as shown)
(If you don't have a 'Member's Login', you will have to create one.)


*Purchaser's Name:

*Telephone #: *E-Mail Address:

Scrip Delivery Method

I will pick up the Scrip at the Rectory.

--- OR ---

Deliver Scrip to my child through the school.

Scrip delivery request and release.

I request, that with this scrip order, the scrip purchased by me, be delivered to me by my child as shown below. I understand that this delivery arrangement is for my convenience. I agree St. Robert's obligation ends once the scrip is delivered to my child. As such, I agree to release and hold St. Robert's harmless for any loss once my scrip is delivered to my child.

*Child's Name: .. *Child's Grade:

Go to:

Grocery - Gas & Auto - Travel Section - Retail Stores

Restaurants - Drug Stores - Entertainment

Revised: February 16, 2010

*

- NOT ON HAND - will be ordered and delivered the following week.

GROCERY
Increments
Store Total $

Cascading Card File

$2.96

Lunardi's
$10

Lunardi's
$25

Mollie Stones
$10

Mollie Stones
$20

Safeway / Pak' N Save
$25

Safeway / Pak' N Save
$100

Smart and Final
$25

Smart and Final
$50

Smart and Final
$100

GAS AND AUTO
Increments
Store Total $

Arco
$50

Chevron
$50

Chevron
$100

Chevron
$250

Jiffy Lube
$30

Shell Prepaid Card
$25
*

Shell
$50
*

Shell
$100
*

Kragen Auto Parts
$25

TRAVEL SECTION
Increments
Store Total $
*

American Airlines
$100
*

American Airlines
$250
*

Avis Car Rental
$50
*

Budget Car Rental
$50
*

Carnival Cruises
$100
*

Comfort Inn
$25
*

Comfort Inn
$100
*

Marriott Hotels
$50
*

Marriott Hotels
$100
*

Marriott Hotels
$500
*

Disney Gift Card
$25
*

Disney Gift Card
$100
*

Disney Gift Card
$1,000

RETAIL STORES
Increments
Store Total $

American Express (prepaid)
$100

American Express (prepaid)
$200

Bath & Body Works
$10

Bath & Body Works
$25
*

Barnes & Noble, B. Dalton
$10

Barnes & Noble, B. Dalton
$25

Bed, Bath & Beyond
$25
*

Best Buy
$25
*

Best Buy
$100
*

Best Buy
$250
*

Borders / Waldenbooks
$10
*

Borders / Waldenbooks
$25
*

Build-A-Bear Workshop
$25
*

Children's Place
$25
*

Circuit City - purchase only
$50
*

Circuit City - purchase only
$100

Claire's
$10
*

Crate & Barrel
$25
*

Crate & Barrel
$100
*

GNC
$25
*

Gymboree
$25

Hallmark
$25

Home Depo
$25

Home Depo
$100
*

Home Depo
$500

J.C. Penny
$25

J.C. Penny
$100
*

Joann Fabrics
$20

Kmart
$25
*

Kohl's Department Store
$25
*

Kohl's Department Store
$100

Lowe's Home Improvement
$25

Lowe's Home Improvement
$100

Lowe's Home Improvement
$500

Lowe's Home Improvement
$1,000
*

Macy's
$25
*

Macy's
$100

Marshalls / T.J. Max
$25
*

Office Depot
$25

Old Navy, Banana Republic, GAP
$25
*

Payless Shoe Source
$20
*

Pier 1 Imports
$25

REI
$25
*

Ross Dress for Less
$25

Sears / Orchard Supply Hardware
(Purchase only)
$25

Sears / Orchard Supply Hardware
(Purchase only)
$100
*

Sears / Orchard Supply Hardware
(Purchase only)
$250
*

Sportmart / Gart / Sports Authority
$25
*

Staples
$25

Toy's R Us / Babies-R-Us
$20

Ulta Salon
$25
*

Wal-Mart
$25
*

Wal-Mart
$100
*

Wal-Mart
$250
*

William Sonoma & Pottery Barn
$25
*

William Sonoma & Pottery Barn
$100

RESTAURANTS
Increments
Store Total $
*

Applebees
$50

Baskin Robbins
$2
*

Buca di Beppo
$25

Burger King
$10

Carl's Jr.
$10
*

Cheescake Factory
$25
*

Chevy's
$25

Chili's / Macaroni Grill
$25
*

Chuck E. Cheese
$10
*

Darden Restaurants - Olive
Garden, Red Lobster
$25
*

Jack in the Box
$10

Jamba Juice
$10
*

Kentucky Fried Chicken
$5
*

Little Ceasar's Pizza
$20
*

Marie Callender's
$25
*

Outback Steakhouse
$25

Peets Coffee
$20
*

Rainforest Cafe
$25

Red Robin
$25

See's Candies
$16.10

Starbucks
$10

Starbucks
$25

Wendy's
$10

DRUG STORES
Increments
Store Total $

CVS
$25

CVS
$100

Walgreen's
$25

Walgreen's
$100

ENTERTAINMENT
Increments
Store Total $

Blockbuster
$10

Century Theatres
$25

EB Games/Game Stop
$25
*

Hollywood Video
$10
*

i-Tunes
$25
*

- NOT ON HAND - will be ordered and delivered the following week.

Enter Total Dollar amount ordered:

If there are other stores you would like Scrip from, let us know: 
                        Revised: November 19, 2008 - © grd

Submitting this form will result in an E-Mail to Christine Peterson, our Scrip Coordinator with your request(s).