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Newman Catholic Foundation Scrip Order Form 2/08/2021
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questions? Call: 641-423-3101 SCRIP orders may be emailed to: sgrandgenett@newmancatholic.org
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Name:_________________________________________Date:__________________________________________
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NEWMAN CODE: 33CCAF88726
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Phone
Home: ___________________________Signature:______________________________________
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Work:____________________________
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_____Send with - Child's Name:______________________________ Grade & Teacher:_____________________
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I WILL PICK SCRIP UP AT:________Elementary________High/Middle________Childcare
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________St. Pat Rectory________Epiphany Parish
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 LOCAL SCRIP - ON HAND
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Business
Donation
ValueQtyTotalBusiness
Donation
ValueQtyTotal
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Kum & Go
5%$25
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Casey's General Store3%$10$100
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$25
Mills Fleet Farm
5%$25
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$50$100
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Fareway
3%$25
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$100
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HyVee - (Food & Drug)
3%$25Scrip Credit Alternatives:
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$50
___ ST.PAT'S
____OTHER FAMILY
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$100
____EPIPHANY
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SCRIP LETTERS FOR VENDORS
SCRIP VENDORS TO PAY DIRECTLY
SCRIP GIFT CERTIFICATES FOR PURCHASE
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BRICK FURNITURE
3%
Home Lumber
3%
ORANGE LEAF
$1010%
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FLOYD & LEONARD
3%
MC Lumber
2%
NATURAL NAILS
$2015%
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FURNITURE MATTRESS
3%
Jeffrey Auto Repair
2%
THE QUARRY
$205%
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KRAMER HARDWARE
7%
Floor to Ceiling
5%
GOD FATHERS PIZZA
$107%
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RAY'S COLLISION
10%
cabinets
3%
TACO JOHNS
$55%
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WOODHARBOR
2%
MASON CITY LASER WASH
$1020%
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AND/OR LASER WASH
(TOKENS)
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Clear View Eye Clinic
10%
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Contact Lenses
5%
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MCCLOSKEY
3%
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HOME LUMBER
3%
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MASON CITY LUMBER
2%
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LOVE & LUCK PHOTO
5%
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SCHUKEI CHEV. SERVICE
5%
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Total Front
$____________________
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Total Back
$____________________
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cashcheck#date
filled by:
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Total Order $____________________
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