2023 RaiseRigtht Order Form

Store Name and Value Total SEE REVERSE
Family Order Form Created : 9 / 11 / 2023
Cornerstone Christian School
Go to Shopwithscrip . com for the complete list of brands and denominations . You may add additional items to this form .
Name
Check #
Student Name
Order Date
Clothing & Accessories
Store Name and Value
% QTY
Total
Store Name and Value
% QTY
Total
Children ' s Place $ 25.00
12 %
$
Dairy Queen $ 10.00
3 %
$
DSW ( Designer Shoe Warehouse )
8 %
$
Domino ' s $ 25.00
8 %
$
DSW ( Designer Shoe Warehouse )
8 %
$
McDonald ' s $ 10.00
2 %
$
Famous Footwear $ 25.00
8 %
$
McDonald ' s $ 25.00
2 %
$
Gap $ 100.00
14 %
$
Panera Bread $ 25.00
8 %
$
Gap $ 25.00
Department Store
14 %
$
Sonic $ 10.00
Starbucks $ 10.00
8 % 4.5 %
$
$
Store Name and Value
% QTY
Total
Starbucks $ 25.00
4.5 %
$
Kohl ' s $ 100.00
4 %
$
Wendy ' s $ 25.00
6 %
$
Kohl ' s $ 25.00
4 %
$
Food & Beverage
Dining - Casual
Store Name and Value
% QTY
Total
Store Name and Value
% QTY
Total
Dunkin ' Donuts $ 10.00
3.5 %
$
Buffalo Wild Wings ® $ 25.00
8 %
$
Dunkin ' Donuts $ 25.00
3.5 %
$
Buffalo Wild Wings ® $ 50.00
Chili ' s Grill & Bar $ 25.00
8 % 11 %
$
$
Gas & Auto
Store Name and Value
% QTY
Total
Chili ' s Grill & Bar $ 50.00
11 %
$
Mobil $ 50.00
1 %
$
Chuck E . Cheese ' s $ 10.00
Texas Roadhouse $ 100.00
8 % 8 %
$
$
Grocery
Product
% QTY
Total
Texas Roadhouse $ 25.00
8 %
$
Stop & Shop ( NOT TOPS ) $ 100.00
4 %
$
TGI Fridays $ 25.00
9 %
$
Stop & Shop ( NOT TOPS ) $ 50.00
4 %
$
Discount Store & Outlets
Health & Beauty
Store Name and Value
% QTY
Total
Store Name and Value
% QTY
Total
Big Lots ! $ 100.00
4 %
$
CVS Pharmacy $ 25.00
6 %
$
Big Lots ! $ 25.00
4 %
$
ULTA $ 25.00
7 %
$
Five Below $ 25.00
2.5 %
$
Walgreens $ 25.00
5 %
$
Sam ' s Club $ 100.00
Sam ' s Club $ 50.00
2.5 % 2.5 %
$
$
Home Decor
Store Name and Value
% QTY
Total
Target $ 100.00
2.5 %
$
HomeGoods $ 100.00
7 %
$
Target $ 25.00
2.5 %
$
HomeGoods $ 25.00
7 %
$
Target $ 50.00
2.5 %
$
Wayfair $ 100.00
6 %
$
Walmart $ 100.00
Walmart $ 50.00
Electronics & Office
2.5 % 2.5 %
$
$
Home Improvement
Store Name and Value
Home Depot ® $ 100.00
% QTY 4 %
Total
$
Store Name and Value
% QTY
Total
Home Depot ® $ 25.00
4 %
$
Best Buy $ 100.00
4 %
$
Lowe ' s $ 100.00
4 %
$
GameStop $ 25.00
5 %
$
Lowe ' s $ 25.00
4 %
$
Entertainment
% QTY
Cinemark $ 25.00
4 %
$
Dave & Buster ' s $ 25.00
13 %
$
Fast Food

Store Name and Value Total SEE REVERSE

Make Checks Payable To : CCS
Total Due All Columns : $