Helen Hyatt Elementary School

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December 13 SCRIP FORM
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The following items are being discontinued and we have a few left to sell:        
Dick's Sporting Goods 3-$25        Gap-5-$20     TGI Friday's 5-$20    T J Maxx 4-$25      
Baskin Robbins  12-$2      Olive Garden-1-$10   Eddie Bauer  1-$20    Home Depot  2-$50  & 1-$100  
                     
Vendors % $ # Net Amount   Vendors % $ # Net Amount
Grocery/Drug           Department Stores        
Russ's Market 5% $20          Prepaid Debit Card        
   Prepaid Debit Card $50       Dillards 9% $25    
    $100       J C Penney 6% $25    
Super Saver 3% $20         6% $100    
   Prepaid Debit Card $50       Sears 4% $25    
    $100           $100    
4 Star Drug 3% $10       Shopko 4% $25    
                $50    
            Wal-Mart/Sam's Club 2% $25    
Restaurants               $100    
Amigo's 10% $5                
Applebee's 8% $20       Specialty Stores        
    $25       Ace Hardware   $25    
Burger King 4% $10       Barnes & Noble 9% $10    
Brueggers Bagels 7% $10           $25    
Carlos O' Kelly 9% $10       Bath & Body Works 13% $10    
Chipotle 6% $10           $25    
Chili's/Macaroni  11% $25       Bed Bath & Beyond 7% $25    
Cold Stone Creamery   $10       Best Buy 2% $25    
Cracker Barrel 8% $10           $100    
Davinci's 10% $5       Circuit City    $25    
            CVS Pharmacy   $25    
KFC 9% $5       Eddie Bauer 12% $25    
Mr. Goodcents 7% $5       Family Christian 9% $25    
Noodles & Co. 8% $10       Gap/Banana/Old Navy 9% $25    
Old Country Buffet 5% $25       Home Depot 3% $25    
Olive Garden 9% $25       Kohl's 4% $25    
Outback 4% $25       Home Depot 4% $100    
Panera 9% $10       Lowe's 4% $25    
Pizza Hut 9% $10       Lowe's 4% $100    
Red Robin 9% $10       Menards 3% $25    
Ruby Tuesday 8% $25       Office Max 5% $25    
Starbucks 7% $10       Payless Shoes 13% $20    
    $25       Pier 1 Imports 4% $10    
Subway 3% $10           $25    
Taco Inn 10% $5       Sally Beauty 12% $25    
Valentinos 9% $5       Steve & Barry 6% $25    
            Toys R Us 3% $20    
                     
            Entertainment        
            Blockbuster Video 7% $10    
                     
Method of Receiving Scrip (check one)          Total Amount Due   _____________________
              payment must accompany order
________ 1.  Send home with student at my risk            
              ________________________________   **The percent listed after each vendor is the amount
                       Student name, grade, teacher   SDA Schools earns even though you pay face value!
                     
________2. Pick up at Helen Hyatt Office     Make checks payable to SDA Schools of Lincoln
                     
Name  _______________________________________            
Address  _____________________________________     Phone (home)  _________________________         ____________________
             ______________________________________               (office)  _________________________                                     Date
                     
                     
**Interested in a vendor not listed please let us know and we will see if it is available.   _____________________