SCRIP Order Form

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Family Order Forms

Created: 5/11/2012 6:50:23 AM

Cavalier Band Boosters


Orders and money are due Friday, May 18. No late orders will be taken.

Name Check #

Customer # Order Date

Apparel & Accessories Product


Aeropostale $25 American Eagle Outfitters $25 Brooks Brothers $25 Claire's $10 Dressbarn $25 Eddie Bauer $25 Express $25 Fashion Bug/Lane Bryant $25 Finish Line $25 Foot Locker $25 Gap/Banana Republic/Old Navy Options $25 Gymboree $25 J. Crew $25 Lands' End $25 Limited $25 Men's Wearhouse $25

Sears $25

**6.00%

Dining - Fine Product % QTY


8.00%

% QTY
7.00% 10.00% 16.00% 9.00% 8.00% 10.00% 10.00% 6.00% 10.00% 9.00% 14.00%

Total
$ $ $ $ $ $ $ $ $ $ $

Dining - Casual Product


Applebee's $25 Applebee's $50 bd's Mongolian Grill $20 Bob Evans $10 Boston Market $10 Buffalo Wild Wings $10 Buffalo Wild Wings $25 Cheesecake Factory $25 Chili's $25 Chuck E. Cheese $10

Total
$

% QTY
**10.00 % **10.00 % 8.00% 10.00% 12.00% 8.00% 8.00% 5.00% 11.00% 8.00% 9.00% 9.00% 9.00% 8.00% 8.00% 13.00% 8.00% 8.00% 9.00% **11.00 % 8.00% 8.00% 9.00%

Total
$ $ $ $ $ $ $ $ $ $

P.F. Chang's $25

Dining - On The Go Product


Arby's $10 Burger King $10 Chipotle Mexican Grill $10 Cold Stone Creamery $10 Domino's $10 Fazoli's $25 Great Harvest Bread $10 Jamba Juice $10 KFC $5

% QTY
8.00% 4.00% 10.00% 8.00% 8.00% 7.00% 6.00% 7.00% 8.00% 8.00% **10.00 % **10.00 % 8.00% 8.00% 7.00% 10.00% 7.00% 7.00% 8.00% 3.00% 5.00% 5.00% 4.00%

Total
$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

13.00% 13.00% **18.00 % 9.00% 8.00%

$ $ $ $ $ $ $ $ $

Cracker Barrel $10 Cracker Barrel $25 Landry's Restaurants $25 Logan's Roadhouse $25 Noodles & Company $10 O'Charley's $25 Olga's Kitchen $20 Outback $25 Red Lobster/Olive Garden $25 Red Robin $25 Ruby Tuesday's $25 Texas Roadhouse $25 TGI Friday's $25

$ $ $

Little Caesars $20 Panera Bread $10 Panera Bread $25

$ $ $ $ $ $ $ $ $ $ Papa John's Pizza $10 Pizza Hut $10 Qdoba $25 Quiznos $10 Starbucks $10 Starbucks $25 Steak 'n Shake $10 Subway $10 Taco Bell $10 Tim Hortons $10 Wendy's $10

Payless Shoes $20 13.00% Talbots $25 The Children's Place $25 TJ Maxx/Marshalls/Ho meGoods $25 13.00% 12.00% 7.00%

Department Store Product


JCPenney $25 Kohl's $25 Macy's $25

% QTY
5.00% 4.00% 10.00%

Total
$ $ $

Make Checks Payable To:

Cavalier Band Boosters

Total Due All Columns:

**Limited time bonus offer. Participating retailers and products are subject to change without notice.

Family Order Forms

Created: 5/11/2012 6:50:23 AM

Cavalier Band Boosters


Orders and money are due Friday, May 18. No late orders will be taken.

Name Check #

Customer # Order Date

Discount Store Product


Kmart $25 Kmart $50 Target GiftCard $25 Target GiftCard $100 Walmart/Sam's Club $25 Walmart/Sam's Club $100

BP Gas Stations $50

1.50% 1.50% 1.50% 8.00% 3.00% 3.00% 2.50% 2.50% 4.00% 4.00% 1.50%

$ $ $ $ $ $ $ $ $ $ $

Home Improvement Product


Ace Hardware $25 Home Depot $25 Home Depot $100 Lowe's $25 Lowe's $500 Lowe's $100

% QTY
4.00% 4.00% 2.00% 2.00% 2.00% 2.00%

Total
$ $ $ $ $ $

Chevron $50 Exxon/Mobil $50 Jiffy Lube $30 Marathon $25 Marathon $100 Shell $25 Shell $50 Speedway $100 Speedway $25

% QTY
4.00% 4.00% 4.00% 4.00% 4.00% 4.00%

Total
$ $ $ $ $ $

Online & Mail Order Product


Amazon.com $25 Amazon.com $100

Electronics & Office Product


Best Buy $25 GameStop $25 Office Depot $25 Office Max $25 RadioShack $25

% QTY
4.00% 4.00% 7.00% **10.00 % **10.00 % **17.00 % 12.00%

Total
$ $ $ $ $ $ $ $ $

% QTY
3.00% 3.00% 4.00% 5.00% 4.00%

Total
Sunoco $50 $

Grocery
$

Product
$ $ $ Gordon Foods Service Marketplace $25 Gordon Foods Service Marketplace $100 Meijer $25 Meijer $50 Meijer $100 $

% QTY
4.00%

Total
$

Groupon.com $25 iTunes $15 iTunes $25

4.00%

$ L.L.Bean $25

Entertainment Product
AMC Theatres/Loews Cineplex $25 AMC Theatres/Loews Cineplex Single Ticket $9.50 Barnes & Noble $10 Barnes & Noble $25 Dave & Buster's $25

% QTY
**12.00 % 16.00%

Total
$

3.00% 3.00% 3.00%

$ $ $

Nike $25

Omaha Steaks $25 11.00% Zappos.com $25 8.00%

Home Decor Product % QTY


7.00% 8.00% 9.00% 8.00%

Service Total
$ $ $ $

Product
Regis Salons $25

% QTY
8.00%

Total
$

9.00% 9.00% 13.00%

$ $ $

Bed Bath & Beyond $25 Crate & Barrel $25 Pier 1 $25 Pottery Barn / Williams-Sonoma $25 Pottery Barn / Williams-Sonoma $100

Specialty Retailer Product % QTY Total


$ $ $ $

Gas & Auto Product


Advance Auto Parts $25 AutoZone $25

Bath & Body Works 13.00% $10 Bath & Body Works 13.00% $25 Build-A-Bear Workshop $25 CVS/pharmacy $25 8.00% 6.00%

% QTY
7.00% 8.00%

Total
$ $

8.00%

Make Checks Payable To:

Cavalier Band Boosters

Total Due All Columns:

**Limited time bonus offer. Participating retailers and products are subject to change without notice.

Family Order Forms

Created: 5/11/2012 6:50:23 AM

Cavalier Band Boosters


Orders and money are due Friday, May 18. No late orders will be taken.

Name Check #

Customer # Order Date

Family Christian Stores $25 GNC $25 Guitar Center $25 Hallmark $25 Honey Baked Ham $25 Jo Ann Fabrics $25 Michaels $25 PetSmart $25 Rite Aid $25 The Container Store $25 Toys R Us/Babies R Us $20 Walgreens $25

9.00% 8.00% 4.00% **5.00% 12.00% 6.00% 4.00% 4.00% 4.00% 9.00% 1.50% 6.00%

$ $ $ $ $ $ $ $ $ $ $ $

Sporting Goods Product


Bass Pro Shops $25 Cabela's $25 Dick's Sporting Goods $25 Dunham's Sports $25 Gander Mountain $25 MC Sports $25 Sports Authority $25

% QTY
**12.00 % 11.00% 8.00% 8.00% 8.00% 8.00% 8.00%

Total
$ $ $ $ $ $ $

Travel Product
Disney $25

% QTY
2.00%

Total
$

Make Checks Payable To:

Cavalier Band Boosters

Total Due All Columns:

**Limited time bonus offer. Participating retailers and products are subject to change without notice.

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