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: April 11, 2015

*

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


GROCERY

Increments
Store Total $


Lucky

$25


Lucky

$100


Lunardi's

$10


Lunardi's

$25


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


Shell 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 $


Bath & Body Works

$10


Bath & Body Works

$25


Bed, Bath & Beyond

$25
*

Best Buy

$25
*

Best Buy

$100
*

Best Buy

$250
*

Build-A-Bear Workshop

$25
*

Children's Place

$25


Claire's

$10
*

Crate & Barrel

$25
*

Crate & Barrel

$100
*

GNC

$25
*

Gymboree

$25


H & M

$25
*

Hallmark

$25


Home Depo

$25


Home Depo

$100
*

Home Depo

$500


J.C. Penny

$25


J.C. Penny

$100
*

Joann Fabrics

$20


Journeys

$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

Sports Authority

$25
*

Staples

$25


Target

$25


Target

$100


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
*

Marie Callender's

$25
*

Outback Steakhouse

$25


Peets Coffee

$20
*

Rainforest Cafe

$25


Red Robin

$25

*

See's Candies

$17.50


Sephora

$20


Starbucks

$10


Starbucks

$25


Wendy's

$10


DRUG STORES

Increments
Store Total $


CVS

$25


CVS

$100


NutriSystem

$50


Walgreen's

$25


Walgreen's

$100


ENTERTAINMENT

Increments
Store Total $


Century Theatres

$25


EB Games/Game Stop

$25

i-Tunes

$15

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:

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