SCRIP ORDER FORMS test

	A	B	C	D	E	F	G	H	I	J	K	L
1	Newman Catholic Foundation Scrip Order Form 11/15/2019
2	questions? Call: 641-423-3101 SCRIP orders may be emailed to: sgrandgenett@newmancatholic.org
3	Name:_________________________________________						Date:__________________________________________
4	NEWMAN CODE: 33CCAF88726
5	Phone	Home: ___________________________					Signature:______________________________________
6		Work:____________________________
7	_____Send with - Child's Name:______________________________ Grade & Teacher:_____________________
8	I WILL PICK SCRIP UP AT:		________Elementary			________High/Middle		________Childcare
9			________St. Pat Rectory					________Epiphany Parish
10	LOCAL SCRIP - ON HAND
13	LOCAL SCRIP - ON HAND
14	Business		Donation	Value	Qty	Total	Business		Donation	Value	Qty	Total
15							Kum & Go		5%	$25
16	Casey's General Store		3%	$10						$100
17				$25			Mills Fleet Farm		5%	$25
18				$50						$100
19	Fareway		3%	$25
20				$100
21	HyVee - (Food & Drug)		3%	$25			Scrip Credit Alternatives:
22				$50			___ ST.PAT'S		____OTHER FAMILY
23				$100			____EPIPHANY
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27	SCRIP LETTERS FOR VENDORS			SCRIP VENDORS TO PAY DIRECTLY				SCRIP GIFT CERTIFICATES FOR PURCHASE
28	BRICK FURNITURE		3%	Home Lumber			3%	ORANGE LEAF		$10		10%
29	FLOYD & LEONARD		3%	MC Lumber			2%	NATURAL NAILS		$20		15%
30	FURNITURE MATTRESS		3%	Jeffrey Auto Repair			2%	THE QUARRY		$20		5%
31	KRAMER HARDWARE		7%	Floor to Ceiling			5%	GOD FATHERS PIZZA		$10		7%
32	RAY'S COLLISION		10%			cabinets	3%	TACO JOHNS		$5		5%
33	WOODHARBOR		2%					MARTIN BROTHERS		$20		10%
34	Consolidated Energy		3%
35	Clear View Eye Clinic		10%
36		Contact Lenses	5%
37	MCCLOSKEY		3%
38	HOME LUMBER		3%
39	MASON CITY LUMBER		2%
40	LOVE & LUCK PHOTO		5%
41	SCHUKEI CHEV. SERVICE		5%
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50								Total Front	$____________________
51								Total Back	$____________________
52	cash	check#	date		filled by:
53								Total Order $____________________
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