Monarch High School Music Boosters - Scrip Shopping Card Order Form

Date: Proceeds to Benefit: (Percent to Total 100%)

Name: ____Scholarship Fund (default) __Choir _ _Indoor Percussion
Email: __ Concert Bands __Orchestra __Marching Band
Phone: _ _Jazz Bands __Winter Guard

Product Rebate Cost Discount Cash/Chk Quantity Total Cost Last 6 Digits:
Albertson’s $100* 5% $102.50 $100
Amazon $10 3% $10.50 $10
Amazon $25 3% $26 $25
Amazon $100 3% $102.50 $100
AMC Theatres $25* 8% $26 $25
Buffalo Wild Wings $10* 8% $10.50 $10
Buffalo Wild Wings $25* 8% $26 $25
Chipotle Mexican Grill $10 10% $10.50 $10
Dick's Sporting Goods $25 8% $26 $25
Einstein Bros. $10 10% $10.50 $10
Home Depot $25 4% $26 $25
iHOP $25 8% $26 $25
iTunes $15 5% $15.50 $15
King Soopers $5 (Reload @Store) 5% $5.50 $5
Kohl’s $25 (pay Kohl’s charge) 4% $26 $25
Kohl’s $100 (pay Kohl’s charge) 4% $102.50 $100
Lowe’s $25* 4% $26 $25
Noodles & Co. $10 8% $10.50 $10
Outback/Carrabba's $25 8% $26 $25
Panda Express $25 8% $26 $25
Panera Bread $10 9% $10.50 $10
Panera Bread $25 9% $26 $25
Qdoba $25 7% $26 $25
Red Robin $25 9% $26 $25
Rock Bottom/Old Chicago $25 6% $26 $25
Safeway $5 (Reload @Store) 5% $5.50 $5
Safeway $100* 4% $102.50 $100
Smashburger $10 10% $10.50 $10
Starbucks $5* 7% $5.50 $5
Starbucks $10* 7% $10.50 $10
Starbucks $25* 7% $26 $25
Subway $10* 6% $10.50 $10
Taco Bell $10* 5% $10.50 $10
Target $25* 2.5% $26 $25
Target $100* 2.5% $102.50 $100
Walmart $100 2.5% $102.50 $100
Wendy’s $10 4% $10.50 $10
Whole Foods $100* 3% $102.50 $100
ORDER TOTALS QTY:_______ $__________
__
*Reload at shopwithscrip.com For additional cards go to shopwithscrip.com or email mhsmusic.sws@gmail.com

Paid By: Credit/Debit _____Cash __Check # Make Checks Payable To: MHS MUSIC BOOSTERS
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