Scrip Order Form

1. Family Order Form Created: 9/20/2011 10:23:01 AM
Round Elementary School PTO/Hartland, MI
IF THERE ARE ANY STORES THAT YOU WOULD LIKE TO SEE ON THE LIST, LET THE PTO KNOW!
Name Customer #
Check # Order Date
Product % QTY Total Product % QTY Total Product % QTY Total
77kids $25.00 10.00% $ Best Western 12.00% $ Elder-Beerman $25.00 8.00% $
International $100.00
Aeropostale $25.00 7.00% $ Exxon $50.00 1.50% $
BP $50.00 1.50% $
Amazon.com $100.00 4.00% $ Fairfield Inn & Suites by 8.00% $
Budget Car Rental 8.00% $ Marriott $100.00
Amazon.com $25.00 4.00% $ $50.00
Fire Mountain $25.00 **6.00 $
Build-A-Bear Workshop 8.00% $ %
AMC Theatres $25.00 **12.00 $ $25.00
% Gander Mountain 8.00% $
Burger King $10.00 **5.00 $ $25.00
American Airlines 8.00% $ %
$100.00 Gap $25.00 14.00% $
Cabela's $100.00 11.00% $
American Eagle 10.00% $
Outfitters $25.00 GFS Marketplace 4.00% $
Cabela's $25.00 11.00% $ $100.00
American Express 1.25% $
$100.00 California Pizza Kitchen **6.00 $ GFS Marketplace 4.00% $
$10.00 % $25.00
American Express 1.25% $
$200.00 Carnival Cruise Lines 8.00% $ GNC $25.00 8.00% $
$100.00
American Express 1.25% $ Great Clips $25.00 8.00% $
$25.00 Carrabba's Italian Grill 8.00% $
$25.00 Great Harvest Bread 6.00% $
Applebee's $25.00 8.00% $ $10.00
Chevron $50.00 1.50% $
Applebee's $50.00 8.00% $ Gymboree $25.00 13.00% $
Chili's Grill & Bar 11.00% $
Avis Car Rental $50.00 8.00% $ $25.00 Hallmark $25.00 4.00% $
Chipotle Mexican Grill 10.00% $
Bahama Breeze $25.00 9.00% $ $10.00 Home Depot $100.00 4.00% $
Baja Fresh $25.00 7.00% $ Chuck E. Cheese 8.00% $ Home Depot $25.00 4.00% $
$10.00
Banana Republic 14.00% $ Claire's $10.00 9.00% $ Home Depot $500.00 4.00% $
$25.00
Cold Stone Creamery 8.00% $ HomeGoods $100.00 7.00% $
Barnes & Noble 9.00% $
Booksellers $10.00 $10.00
HomeGoods $25.00 7.00% $
Barnes & Noble 9.00% $ Country Buffet $25.00 **6.00 $
Booksellers $100.00 % Hometown Buffet **6.00 $
$25.00 %
Barnes & Noble 9.00% $ Courtyard by Marriott 8.00% $
Booksellers $20.00 $100.00 IHOP $25.00 8.00% $
Barnes & Noble 9.00% $ Cracker Barrel $10.00 9.00% $ iTunes® $15.00 **8.00 $
Booksellers $25.00 %
CVS/pharmacy $100.00 6.00% $
Bass Pro Shops 9.00% $ iTunes® $25.00 **8.00 $
$100.00 CVS/pharmacy $25.00 6.00% $ %
Bass Pro Shops $25.00 9.00% $ JCPenney $100.00 **7.00 $
Darden Restaurants 9.00% $
$25.00 %
Bath & Body Works 13.00% $
$10.00 Dave & Buster's $25.00 13.00% $ JCPenney $25.00 **7.00 $
%
Bath & Body Works 13.00% $
$25.00 Dick's Sporting Goods 8.00% $ Jo-Ann Fabrics $20.00 6.00% $
$25.00
bd's Mongolian Grill 8.00% $ KFC $5.00 8.00% $
$20.00 Disney $100.00 2.00% $
Bed Bath & Beyond 7.00% $ Disney $1000.00 2.00% $ Kohl's $100.00 4.00% $
$100.00
Disney $25.00 2.00% $ Kohl's $25.00 4.00% $
Bed Bath & Beyond 7.00% $
$25.00 Domino's Pizza $10.00 8.00% $ Lands' End $100.00 16.00% $
Best Buy $100.00 3.00% $ Lands' End $25.00 16.00% $
Dunham's Sports 8.00% $
Best Buy $25.00 3.00% $ $25.00
Lands' End Kids 16.00% $
Elder-Beerman $100.00 8.00% $ $100.00
Best Buy $250.00 3.00% $
Make Checks Payable To: Round PTO Total Due All Columns: $
**Limited time bonus offer. Participating retailers and products are subject to change without notice.

2. Family Order Form Created: 9/20/2011 10:23:01 AM
Round Elementary School PTO/Hartland, MI
IF THERE ARE ANY STORES THAT YOU WOULD LIKE TO SEE ON THE LIST, LET THE PTO KNOW!
Name Customer #
Check # Order Date
Product % QTY Total Product % QTY Total Product % QTY Total
Lands' End Kids $25.00 16.00% $ P.F. Chang's China 8.00% $ Sears $250.00 4.00% $
Bistro $25.00
Lands' End School 16.00% $ See's Candies $16.50 20.00% $
$100.00 Panera Bread $10.00 9.00% $
Sephora $20.00 4.00% $
Lands' End School 16.00% $ Panera Bread $25.00 9.00% $
$25.00 Shell $100.00 2.50% $
Papa John's Pizza 8.00% $
Little Caesar's Pizza 8.00% $ $10.00
$20.00 Shell $25.00 2.50% $
Payless Shoes $20.00 13.00% $
Longhorn Steakhouse 9.00% $ Shell $50.00 2.50% $
$25.00 PBteen $100.00 8.00% $
Lowe's $100.00 4.00% $ Shutterfly $25.00 9.00% $
PBteen $25.00 8.00% $
Lowe's $1000.00 4.00% $ Speedway $100.00 4.00% $
Pei Wei Asian Diner 8.00% $
Lowe's $20.00 4.00% $ $25.00 Speedway $25.00 4.00% $
PetSmart $25.00 4.00% $ SpringHill Suites by 8.00% $
Lowe's $25.00 4.00% $
Marriott $100.00
Pier 1 Imports $25.00 9.00% $
Lowe's $500.00 4.00% $ St. Louis Bread 9.00% $
Pizza Hut $10.00 8.00% $ Company $10.00
Macaroni Grill $25.00 11.00% $
Staples $100.00 5.00% $
Pottery Barn $100.00 8.00% $
Macy's $100.00 10.00% $
Staples $25.00 5.00% $
Pottery Barn $25.00 8.00% $
Macy's $25.00 10.00% $
Starbucks $10.00 7.00% $
Pottery Barn Kids 8.00% $
Maggiano's Little Italy 11.00% $ $100.00
$25.00 Starbucks $25.00 7.00% $
Pottery Barn Kids 8.00% $
Marathon $100.00 3.00% $ $25.00 Subway $10.00 **4.00 $
%
Marathon $25.00 3.00% $ Qdoba Mexican Grill 7.00% $
$25.00 Subway $50.00 **4.00 $
Marriott Hotels & 8.00% $ %
Resorts $100.00 Quiznos $10.00 10.00% $
Suncoast Smoothies 8.00% $
Marshalls $100.00 7.00% $ Radio Shack $25.00 4.00% $ $20.00
T.J. Maxx $100.00 7.00% $
Marshalls $25.00 7.00% $ Red Lobster $25.00 9.00% $
T.J. Maxx $25.00 7.00% $
Michaels $25.00 4.00% $ Renaissance Hotels & 8.00% $
Resorts by Marriott Tanger Outlets $25.00 8.00% $
Mobil $50.00 1.50% $ $100.00
Residence Inn by 8.00% $ Target $100.00 2.00% $
Office Depot $100.00 4.00% $
Marriott $100.00
Target $25.00 2.00% $
Office Depot $25.00 4.00% $ Rich $100.00 4.00% $
TGI Friday's $25.00 9.00% $
Office Max $100.00 5.00% $ Rich $25.00 4.00% $
Tim Hortons $10.00 5.00% $
Office Max $25.00 5.00% $ Rocky Mountain **13.00 $
Chocolate Factory % TownePlace Suites by 8.00% $
Old Country Buffet **6.00 $ $10.00 Marriott $100.00
$25.00 %
Ruby Tuesday $25.00 8.00% $ Toys-R-Us $20.00 1.50% $
Old Navy $25.00 14.00% $
Ryan's Grill Buffet and **6.00 $ ULTA $25.00 4.00% $
Olga's Kitchen $20.00 8.00% $ Bakery $25.00 %
VG's Grocery $100.00 2.00% $
Olive Garden $25.00 9.00% $ Sally Beauty Supply 12.00% $
$25.00
VG's Grocery $25.00 2.00% $
Omaha Steaks $25.00 11.00% $
Sam's Club $100.00 2.00% $
Walgreens $100.00 6.00% $
On The Border $25.00 11.00% $
Sam's Club $25.00 2.00% $
Walgreens $25.00 6.00% $
Outback Steakhouse 8.00% $
Sam's Club $250.00 2.00% $
$25.00 Walmart $100.00 2.00% $
Overstock.com $25.00 8.00% $ Sears $25.00 4.00% $
Make Checks Payable To: Round PTO Total Due All Columns: $
**Limited time bonus offer. Participating retailers and products are subject to change without notice.

3. Family Order Form Created: 9/20/2011 10:23:01 AM
Round Elementary School PTO/Hartland, MI
IF THERE ARE ANY STORES THAT YOU WOULD LIKE TO SEE ON THE LIST, LET THE PTO KNOW!
Name Customer #
Check # Order Date
Product % QTY Total
Walmart $25.00 2.00% $
Walmart $250.00 2.00% $
Wendy's $10.00 4.00% $
Wet Seal $25.00 5.00% $
Whole Foods Market 3.00% $
$100.00
Whole Foods Market 3.00% $
$25.00
Williams-Sonoma 8.00% $
$100.00
Williams-Sonoma 8.00% $
$25.00
Zappos.com $25.00 8.00% $
Make Checks Payable To: Round PTO Total Due All Columns: $
**Limited time bonus offer. Participating retailers and products are subject to change without notice.