Help us build a new computer lab!

2014 ORDERING SCHEDULE

Perfect for Holiday Gift Shopping!!
PAYMENT & ORDER DUE
Friday November 14
Friday November 21
Friday December 5
Friday December 12

CARDS DISTRIBUTED
Friday November 21
Monday December 1
Friday December 12
Friday December 19

Next BRONCO BUCKS order is DUE this Friday November 14th. Take advantage of gift cards for your
household AND holiday shopping while helping to raise money for our school computer lab! It is FAST,
EASY and has helped to raise hundreds of $$$ for our school already!
Thank you in advance for your support!

Independence Elementary PTO

**********************************************************************************************

BRONCO BUCKS ORDERING

** Attached Enrollment Form must be completed in conjunction with first order being placed **
Questions/Contact: Sarah Malys (248-210-8164 / sarah.malys@53.com)

SHOP ON-LINE (PREFERRED METHOD) ** Easiest and Fastest! **

1.

Create your Family Account at www.shopwithscrip.com ( Enrollment Code L89CL61A4LL58)

2.

Click on Shop in the upper right to view hundreds of gift cards options. For many retailers you may choose
between a physical gift card (to be distributed approximately one week after order is due) OR a ScripNow
option which allows for much quicker turnaround and the ability to print out directly from your
computer.

3.

Two options for payment:

1) Set up PrestoPay via the website. This process takes 2-3 days to complete, however once your bank
account is verified, you may pay for your order directly on-line.
OR
2) Pay via check payable to Independence Elementary PTO. Payment MUST be received by specified
due date on ordering schedule. Please submit in an envelope labeled Scrips Order to your childs
teacher.

*****************************************************************************************
If you are unable to shop via the website, you may complete the attached Family Order Form and return with
check payment (payable to Independence Elementary PTO) by specified deadline. Please submit in an envelope
labeled Scrips Order to your childs teacher.
*****************************************************************************************
Card Distribution: Physical gift cards will be distributed approximately one week after money is due. Please note if
you would like your card sent home with your child OR held for you in the school office. Attached Waiver of
Responsibility must be signed and returned if you would like the cards sent home with your child.

Created: 11/12/2014 9:45:22 AM

Family Order Form

Independence Elementary PTO

Order form and check payment DUE by Friday 11/14/14 (pickup by 11/21/14). Please note if you would like your card sent home (note
child's name and teacher) OR held in the school office. Hundreds more stores/denominations on-line!
Name

Customer #

Check #

Order Date

Product

Total

Product

Total

Product

1-800-Flowers $25.00

12%

California Pizza Kitchen

$10.00

8%

Express $25.00

Ace Hardware $25.00

4%

Caribou Coffee $10.00

6%

13%

8%

Aeropostale $25.00

7%

Carrabba's Italian Grill

$25.00

Amazon.com $25.00

3%

Carson's $25.00

8%

AMC Theatres $10.00

8%

Cheesecake Factory
$25.00

5%

American Girl $25.00

9%

Cheryl's Cookies $25.00

12%

Applebee's $25.00

8%

Children's Place $25.00

12%

Arby's $10.00

8%

Chili's Grill & Bar $25.00

11%

Athleta $25.00

14%

Chipotle Mexican Grill

$10.00

10%

3%

Christmas Tree Shops

$25.00

7%

Chuck E. Cheese
$10.00

8%

Claire's $10.00

9%

Clarion Hotels $50.00

4%

Cold Stone Creamery

$10.00

8%

Comfort Inn $50.00

4%

Hallmark $25.00

adidas $25.00

Babies"R"Us $20.00
Banana Republic
$25.00

% QTY

14%

Barnes & Noble $10.00

9%

Bass Pro Shops $25.00

9%

% QTY

Total
$

1%

Family Video $10.00

12%

Fleming's Prime
Steakhouse $25.00

8%

Foot Locker $25.00

9%

GameStop $25.00

3%

Gander Mountain
$25.00

8%

14%

GFS Marketplace
$25.00

4%

GNC $25.00

8%

Golfsmith $25.00

8%

Great Harvest Bread

$10.00

6%

Groupon.com $25.00

7%

Guitar Center $25.00

4%

13%

Exxon $50.00

Gap $25.00

Bath & Body Works

$10.00

13%

bd's Mongolian Grill

$20.00

8%

Bed Bath & Beyond

$25.00

7%

Country Buffet $25.00

5%

Hard Rock Cafe $25.00

Best Buy $25.00

3%

Cracker Barrel $10.00

9%

Body Shop $25.00

8%

Crate and Barrel $25.00

% QTY
10%

Gymboree $25.00

4%

10%

Hardee's $10.00

5%

8%

HomeGoods $25.00

7%

13%

Honey Baked Ham

$25.00

12%

3%

iTunes $15.00

5%

13%

J. Crew $25.00

13%

jcpenney $25.00

5%

Jo-Ann Fabric and Craft

Stores $25.00

6%

10%

Bonefish Grill $25.00

8%

Crazy 8 $25.00

BoRics $25.00

8%

Dairy Queen $10.00

BP $100.00

1.5%

Dave & Buster's $25.00

BP $50.00

1.5%

Del Taco $10.00

4%

Bravo Cucina Italiana

$25.00

12%

Dell Computer $100.00

4%

Brio Tuscan Grille

$25.00

12%

Destination Maternity
$25.00

8%

Bruegger's Bagels
$10.00

7%

Dick's Sporting Goods

$25.00

8%

KFC $5.00

8%

Dillard's $25.00

9%

Kmart $25.00

4%

Disney $25.00

2%

Kohl's $25.00

4%

Domino's Pizza $10.00

8%

L.L.Bean $25.00

16%

Dunham's Sports
$25.00

8%

Lands' End $25.00

16%

3%

Limited $25.00

9%

Eddie Bauer $25.00

10%

Little Caesar's Pizza

$20.00

8%

Einstein Bros. Bagels

$10.00

10%

Lord & Taylor $25.00

8%

Lowe's $25.00

4%

Buca di Beppo $25.00

8%

Buckle $25.00

8%

Buffalo Wild Wings

$25.00

8%

Build-A-Bear Workshop
$25.00

8%

Burger King $10.00

4%

Burlington Coat Factory

$25.00

8%

11%

Cabela's $25.00

Dunkin' Donuts $10.00

Make Checks Payable To:

Independence Elementary PTO

Journeys $25.00

Total Due All Columns:

Created: 11/12/2014 9:45:22 AM

Family Order Form

Independence Elementary PTO

Order form and check payment DUE by Friday 11/14/14 (pickup by 11/21/14). Please note if you would like your card sent home (note
child's name and teacher) OR held in the school office. Hundreds more stores/denominations on-line!
Name

Customer #

Check #

Order Date

Product

Total

Product

Total

Product

11%

Pottery Barn $25.00

8%

Under Armour $25.00

11%

Marathon $25.00

3%

Qdoba Mexican Grill

$25.00

7%

Uno Pizzeria & Grill

$25.00

12%

Marshalls $25.00

7%

Red Lobster $25.00

9%

Walgreens $25.00

6%

Mason Street Grill

$25.00

9%

Red Robin $25.00

Maggiano's Little Italy

$25.00

% QTY

McCormick & Schmick's

$25.00

9%

Meijer (not AK and HI)

$25.00

3%

Michaels $25.00

4%

Mobil $50.00

1%

Morton's Steakhouse
$25.00

9%

Motherhood Maternity
$25.00

8%

Muer Seafood $25.00

9%

Nike $25.00

% QTY

9%

Walmart $25.00

2.5%

50%

Wendy's $10.00

4%

Restoration Hardware
$25.00

12%

West Elm $25.00

8%

Rite Aid $25.00

4%

Wet Seal $25.00

5%

Ruby Tuesday $25.00

8%

Whole Foods Market

$25.00

3%

Sally Beauty Supply

$25.00

12%

Williams-Sonoma
$25.00

8%

Sam's Club $25.00

2.5%

Younkers $25.00

8%

Sears $25.00

4%

Zappos.com $25.00

8%

Sephora $20.00

5%

2.5%

12%

Shell $25.00

8%

Shutterfly $25.00

9%

Office Depot $25.00

4%

Speedway $25.00

4%

5%

Sports Authority $25.00

8%

14%

Staples $25.00

5%

Olive Garden $25.00

9%

Star Theatres $25.00

8%

On The Border $25.00

11%

Starbucks $10.00

7%

Steak 'n Shake $10.00

8%

Stein Mart $25.00

7%

SUBWAY Restaurants
$10.00

3%

Sunglass Hut $25.00

12%

Sunoco $50.00

1.5%

T.J.
Maxx/Marshalls/HomeG
oods $100.00

7%

Taco Bell $10.00

5%

Tanger Outlets $25.00

8%

2.5%

TGI Fridays $25.00

9%

The Home Depot

$25.00

4%

Tim Hortons $10.00

5%

Toys"R"Us $20.00

3%

ULTA $25.00

4%

Old Navy $25.00

Oriental Trading
Company $25.00

9%

Outback Steakhouse
$25.00

8%

Overstock.com $25.00

8%

P.F. Chang's China

Bistro $25.00

8%

Panera Bread $10.00

9%

Papa John's Pizza

$10.00

8%

13%

Pei Wei Asian Diner

$25.00

8%

PetSmart $25.00

4%

Pier 1 Imports $25.00

9%

14%

8%

Pizzeria Uno $25.00

12%

Plum Market $50.00

3%

Payless Shoes $20.00

Piperlime $25.00
Pizza Hut (Not AK or HI)
$10.00

Target $25.00

Make Checks Payable To:

Total

Restaurant.com $20.00

Noodles & Company

$10.00

Office Max $25.00

% QTY

Independence Elementary PTO

Total Due All Columns:

Enrollment Form
Independence Elementary PTO Scrips Program (Bronco Bucks)
PROGRAM RULES AND GUIDELINES: Please read carefully before completing the form.
** Must be completed and returned to Bronco Bucks Coordinator in conjunction with first order **
1.

All orders must be accompanied by cash, check or money order made payable to Independence Elementary

PTO. Scrip purchases are not tax deductible because you receive dollar of dollar value.
2.

If your check is returned because of non-sufficient funds (NSF) you will be charged a $30 fee payable to

Independence Elementary PTO. After 2 NSF checks are tendered on your account, your scrip privileges will be limited
to cash or money order only.
3.

Scrip certificates are purchased on your behalf and are not returnable.

4.

When you receive your certificates, open your order and verify its accuracy. In the unlikely event you should

find a discrepancy in your order, please contact one of the scrip coordinators immediately.
5.

Scrip certificates are the same as cash and should be handled accordingly. Independence Elementary PTO will

not be responsible for certificates that are lost, stolen or misplaced once given to your child.
6.

You must sign the Waiver of Responsibility section of this form before certificates will be released to your

child. Independence Elementary PTO accepts no responsibility for certificates delivered in this manner. Otherwise,
your certificates may be picked up in the school office.

Name (first and last): _______________________________

Address: ____________________________________________
Phone Number: _______________(home) _______________(cell)
Email Address: _____________________
I have read and understand the policies and guidelines listed above, and I agree to abide by these policies.
Signature ______________________________
Date

_______________

Waiver of Responsibility
The following waiver of responsibility will allow us to send your SCRIP order home with your child. Please complete the
waiver form if you elect this option and return it to school. If you do NOT have a waiver on file, your SCRIP order can be
picked up in the school office.
WAIVER OF RESPONSIBILITY
I hereby grant my permission for the Independence Elementary PTO to send my order of SCRIP certificates home with
my child_________________________ in _________________s classroom. I understand that I accept full
responsibility for the certificates and that the Independence Elementary PTO, Independence Elementary School and
the Clarkston School District have NO responsibility for the certificates once they are delivered to my child. This
permission shall remain in effect for the 2014-2015 school year or until I provide written notice to rescind it.
Print name:_________________________________________
Address:____________________________________________
Home phone:______________________Work phone:___________________
Signature:________________________________Date:____________________