St. John the Baptist Parish SCRIP Order Form Please enter your information and quantity of each SCRIP you would like to order. Click on the store names to view details about SCRIP. Once your order is placed, please bring your payment to the Parish Office.

First Name:		Last Name:
Phone:		Email:
Date:	7/6/2008	Delivery Method:	Send home with child at St. John's Send home with child at Kinder Kountry Parish Office / Mass

Dry Cleaners Profit SCRIP Qty Subtotal Clayton's Dry Cleaners 5% $10.00 Clayton's Dry Cleaners 5% $20.00 Don's Cleaners 6% $10.00   Fast Food Profit SCRIP Qty Subtotal G.D. Ritzy's 5% $20.00 Great Harvest Bread Co. 10% $5.00 Great Harvest Bread Co. 10% $10.00 Lic's 33% $2.00   Gas Station Profit SCRIP Qty Subtotal A-Plus (Sunoco) 2% $50.00 Chevron 1.5% $50.00 Exxon 1.5% $50.00 GetGo (Giant Eagle) 4% $25.00 Holiday StationStores 2% $25.00 Marathon Gas 3% $25.00 Mobil (Exxon) 1.5% $50.00 Sheetz Gasoline 3% $25.00 Shell 2% $25.00 Shell (CA, MA, ME, NH, CT ONLY) 2% $50.00   Gas Stations Profit SCRIP Qty Subtotal Thorton's 5% $10.00   Grocery Profit SCRIP Qty Subtotal A&P Food Stores 4% $25.00 Bi-Lo (W. PA) 4% $10.00 Bruno's Supermarket 5% $25.00 Cub Foods 2% $25.00 Family Fare (W. MI only) (Spartan) 2% $25.00 Farmer Jack's (A&P) 4% $25.00 Food Emporium (A&P) 4% $25.00 Food Fair / AL, GA (Bruno's) 5% $25.00 Food Max / AL, FL, GA (Bruno's) 5% $25.00 Food Maxx (Save Mart) 2% $25.00 Food World / AL,FL, GA (Bruno's) 5% $25.00 GFS Marketplace 4% $25.00 Giant Eagle 4% $25.00 Glen's Market (MI only) (Spartan) 2% $25.00 Martin's Food Market (Stop & Shop) 4% $25.00 P&C/NY&PA 4% $10.00 Pharm 4% $25.00 Quality/Buffalo & Erie 4% $10.00 Randall's - TX only 3% $25,100.00 Safeway-TX ONLY 3% $25.00 Sav-A-Center (A&P) 4% $25.00 Save Mart Supermarkets 2% $25.00 SaveRite Grocery Warehouse (Winn Dixie) 4% $25.00 Schwan's (GR area Only-see zip codes) 4% $20.00 Shop 'N Save (St. Louis, MO/Springfield, IL only) 4% $10.00 ShopRite 4% $20.00 Smart & Final 3% $25.00 S-Mart Foods (Save Mart) 2% $25.00   Grocery Stores Profit SCRIP Qty Subtotal Buehler's Buy Low 5% $25.00 Rivertown Butcher Shop 5% $10.00 Rivertown Butcher Shop 5% $25.00 Schnuck's 5% $25.00 Schnuck's 5% $100.00 Wesselman's 5% $10.00 Wesselman's 5% $25.00   Lodging And Travel Provider Profit SCRIP Qty Subtotal American Airlines 16% $50.00 Best Western Int'l 12% $25.00 Beverly Garland's Holiday Inn - North Hollywood, CA (Marcus) 5% $10.00 Carnival Cruises (restrictions apply) 8% $100.00 Courtyard (Marriott) 12% $25.00 Crowne Plaza Northstar - Minneapolis, MN (Marcus) 5% $10.00 Fairfield Inn (Marriott) 12% $25.00 Grand Geneva Resort - Lake Geneva, WI (Marcus) 5% $10.00 Hilton Garden Inn Houston Northwest - Houston, TX (Marcus) 5% $10.00 Hilton Madison Monona Terrace - Madison, WI (Marcus) 5% $10.00 Hotel Mead - Wisconsin Rapids, WI (Marcus) 5% $10.00 Hotel Phillips - Kansas City, MO (Marcus) 5% $10.00 Marcus Resorts 5% $10.00 Miramonte Resort - Indian Wells, CA (Marcus) 5% $10.00 Pfister Hotel - Milwaukee, WI (Marcus) 5% $10.00   Other Retail Profit SCRIP Qty Subtotal Action Pest Control 10% $50.00   Other Scrip Provider Profit SCRIP Qty Subtotal AMC Theatres 7% $25.00 AT&T 100+ min 20% $9.50 AT&T 60 min 20% $6.25 B.F.I. of West Michigan (Sunset) 10% $20.00 Celebration Cinema 4% $10.00 Cinema Carousel (Muskegon, MI) (Celebration) 4% $10.00 Cineplex Odeon (Loew's Cineplex) 13% $25.00 Crystal Flash (MI only) 3% $50.00 iTunes 5% $15.00 Loeks Theatres/MI Only (Celebration) 4% $10.00 Loews Cineplex Entertainment 13% $25.00 Magic Johnson Theatre (Loew's) 13% $25.00 Marcus Theatres 5% $10.00 Multiple Retailer Card (Restrictions apply) To order, look under Multiple Retailer 5% $25.00 Plaza 1& 2 (Muskegon, MI) (Celebration Cinema) 4% $10.00 Scrip Wallet 15% $1.00 Shorline Waste (Sunset Waste) 10% $20.00 Sony Theatres (Loew's Cineplex) 13% $25.00   Restaurant Profit SCRIP Qty Subtotal 84 East Pasta (Dining Concepts) 5% $25.00 8th Street Grille (Dining Concepts) 5% $25.00 A & W 5% $5.00 Alpenrose (Dining Concepts) 5% $25.00 Amway Grand Plaza (Dining Concepts) 5% $25.00 Applebee's 8% $20.00 Arby's 10% $5.00 Auntie Pasta's Caf? Zio's Pub (Schelde's) 9% $10.00 Babin's Seafood House (Landry's) 9% $25.00 Baja Fresh 7% $25.00 Baskin Robbins 9% $2.00 Bastone (Schelde's) 9% $10.00 BD's Mongolian BBQ 8% $20.00 Beechwood Inn/Coyote Caf?Dining Concepts) 5% $25.00 Big Bowl (Lettuce Entertain You) 12% $25.00 Big Fish (Landry's) 9% $25.00 Bite (Dining Concepts) 5% $25.00 Blue Water Grill (Dining Concepts) 5% $25.00 Bob Evans 10% $5.00 Bonanza (Bennigan's) 12% $25.00 Bonfire (Schelde's) 9% $10.00 Brann's 9% $10.00 Brenner's Steakhouse (Landry's) 9% $25.00 Bruegger's Bagels 5% $10.00 Burger King 4% $5.00 Cadillac Bar (Landry's) 9% $25.00 Caf?abana (Schelde's) 9% $10.00 Calypso's (Dining Concepts) 5% $25.00 Cantina Laredo (Spaghetti Warehouse) 18% $20.00 Carl's Jr 9% $5.00 Cass Lake Roadhouse (Schelde's) 9% $10.00 Champps Restaurant & Bar 5% $25.00 Chaps (Dining Concepts) 5% $25.00 Cheeseburger in Paradise (Outback) 4% $25.00 Chequers (Dining Concepts) 5% $25.00 Chick-Fil-A 4% $5.00 Chili's 11% $20.00 Chuck E. Cheese 8% $10.00 Cinq (Schelde's) 9% $10.00 Claim Jumper 8% $25.00 Clementine's (Dining Concepts) 5% $25.00 Clementine's Too (Dining Concepts) 5% $25.00 Coffee Bean & Tea Leaf 9% $25.00 Corner Bakery Caf?Chili's) 11% $20.00 Country Seasons (Dining Concepts) 5% $25.00 Cracker Barrel 9% $10.00 Crazy Horse Steakhouse (Dining Concepts) 5% $25.00 Daily Grill (Dining Concepts) 5% $25.00 Damon's 9% $25.00 D'Angelo Sandwich Shops (CT, MA, ME, NH, RI, VT) 11% $5.00 Darden (Red Lobster) 9% $25.00 Dave & Busters 8% $25.00 Del Taco 6% $5.00 Denny's 9% $5.00 Dining Concepts 5% $25.00 Domino's Pizza 5% $5.00 Don Pablo's 8% $25.00 Donatos Pizza 10% $5.00 Downtown Aquarium (Landry's) 9% $25.00 Eat 'n Park 10% $5.00 El Chico (Spaghetti Warehouse) 18% $20.00 Finley's (MI only) 9% $10.00 Fisherman's Wharf (Landry's) 9% $25.00 Flat River Grill (Dining Concepts) 5% $25.00 Flying Dutchman (Landry's) 9% $25.00 Fox & Hound's/Bailey's 8% $25.00 Friendly's Restaurant 12% $10.00 Gandy Dancer (Landry's) 9% $25.00 Garfield's 8% $10.00 Golden Corral 3% $5.00 Good Eats (Spaghetti Warehouse) 18% $20.00 Great Harvest Bread Co 8% $10.00

Restaurant Profit SCRIP Qty Subtotal Grizzly Peak Brewing Co. (Schelde's) 9% $10.00 Grotto (Landry's) 9% $25.00 Heavenly Ham 8% $25.00 Inn At Hawks Head (Dining Concepts) 5% $25.00 Jack in the Box 4% $25.00 Jamba Juice 7% $10.00 James Street Inn (Dining Concepts) 5% $25.00 JJ Finnegans (Dining Concepts) 5% $25.00 KaleidoScoops 8% $3.00 Kirby House (Dining Concepts) 5% $25.00 Krispy Kreme (CA, MI, PA only) 16% $10.00 La Griglia (Landry's) 9% $25.00 Lee Roy Selmon's (Outback) 4% $25.00 Leo's Restaurant - Grand Rapids, MI only 9% $25.00 Logan's Roadhouse 8% $25.00 Long John Silver's 9% $5.00 Longhorn Steakhouse 11% $25.00 Lou Malnati's 8% $10.00 Lucky's Caf?Spagetti Warehouse) 18% $20.00 Macaroni Grill (Chili's) 11% $20.00 Maggiano's Little Italy (Chilli's) 11% $20.00 Marie Callendar's 18% $25.00 Max & Erma's 13% $10.00 Mermaid Bar and Grill (Dining Concepts) 5% $25.00 Mr. Goodcents Subs & Pastas 7% $5.00 New Holland Brewing (Dining Concepts) 5% $25.00 North Peak Brewing Company (Schelde's) 9% $10.00 Ocean Journey Aquarium (Landry's) 9% $25.00 O'Charley's 13% $25.00 Old Boys' Brewhouse (Dining Concepts) 5% $25.00 Olga's Kitchen 8% $20.00 Olive Garden (Red Lobster) 9% $25.00 On The Border (Chili's) 11% $20.00 Orlando's Italian Restaurant (Dining Concepts) 5% $25.00 Ottawa Beach Inn (Dining Concepts) 5% $25.00 Outback Steakhouse 4% $25.00 Panera Bread 9% $10.00 Papa Gino's (CT, MA, ME, NH, RI) 11% $5.00 Papagus (Lettuce) 12% $25.00 Parkway Inn (Dining Concepts) 5% $25.00 Paul Lee's Chinese Kitchen (Outback) 4% $25.00 Peet's Coffee & Tea 8% $20.00 Peohe's (Landry's) 9% $25.00 Pereddies Italian Restaurant (Dining Concepts) 5% $25.00 Pesce (Landry's) 9% $25.00 Pick Up Stix 12% $5.00 Pietro's -MI only (Finley's) 9% $10.00 Pigeon Lake Lodge (Dining Concepts) 5% $25.00 Pinheads Gutters & Grub (Dining Concepts) 5% $25.00 Piper (Dining Concepts) 5% $25.00 Pizza Hut 9% $10.00 Plano Tavern (Bennigan's) 12% $25.00 Ponderosa (Bennigan's) 12% $25.00 Red Lobster 9% $25.00 Restaurant Toulouse (Dining Concepts) 5% $25.00 Rosebud Bar & Grill (Dining Concepts) 5% $25.00 Rose's Express (Dining Concepts) 5% $25.00 Rose's on Reed's Lake (Dining Concepts) 5% $25.00 Saint Louis Bread Co. (Panera) 9% $10.00 Saltgrass (Landry's) 9% $25.00 Schelde Restaurants (MI only) 9% $10.00 Smokey Bones BBQ (Red Lobster) 9% $25.00 Southside Inn (Dining Concepts) 5% $25.00 Spaghetti Warehouse 18% $20.00 Spectators Sports Bar & Grill (Dining Concepts) 5% $25.00 Stable Inn (Dining Concepts) 5% $25.00   Restaurants Profit SCRIP Qty Subtotal Edgewater Grille 20% $20.00 Knob Hill 15% $10.00 Knob Hill 15% $20.00 Pizza Chef 10% $10.00 Pizza Chef 10% $20.00 Pizza King 10% $10.00 Pizza King 10% $15.00 Pizza King 10% $20.00 Pizza King 10% $25.00   Retail Store Profit SCRIP Qty Subtotal 1-800-Flowers 8% $15.00 Ace Hardware 4% $25.00 Advance Auto Parts 7% $25.00 Afterthoughts (Claire's) 9% $10.00 Amazon.com 7% $25.00 American Eagle Outfitters 8% $25.00 Andersons 4% $25.00 Artex 5% $20.00 Babies-R-Us (Toys-R-Us) 3% $20.00 Barnes & Noble Bookstores 9% $10.00 Bath & Body Works 13% $10.00 Beall's (FL, GA, AZ only) 9% $25.00 Bed Bath & Beyond 7% $25.00 Best Buy 2% $25.00 Big 5 Sporting Goods 8% $25.00 Blockbuster Gift Card 7% $10.00 Blockbuster Night Card 15% $12.00 Blockbuster Single Game Rental 15% $6.00 Blockbuster Single Video Rental 15% $3.79 Bon-Ton 9% $25.00 Borders (Waldenbooks) 8% $10.00 Brooks Brothers 16% $25.00 Build-A-Bear Workshop 8% $25.00 Camera Shop (Ritz Camera) 6% $25.00 Casual Corner 19% $25.00 Checker/Schuck's/Kragen Auto Parts 8% $25.00 Circuit City 3% $50.00 CompUSA 4% $25.00 Cornerstone 10% $10.00 CSK Auto (Checker) 8% $25.00 CVS Pharmacy 2% $25.00 Dick's Sporting Goods 8% $25.00 DSW Shoe Warehouse 9% $25.00 Eddie Bauer 9% $25.00 Elder-Beerman 9% $25.00 Footlocker Stores/Lady Footlocker/Kid's Footlocker 9% $10.00 Gap/Gap Kids/Baby Gap 9% $25.00 Gart Sports (Sports Authority) 8% $25.00 Goody's 5% $25.00 Gordman's 7% $25.00 HD Landscape Supply (Home Depot) 3% $100.00 HeadStart Hair Care 8% $25.00 Holiday Hair (Regis) 8% $25.00 Hollywood Video 15% $10.0