| Cust. # ___________________ | | Date _____/_____/_____ | |
| Parent's Name ____________________________ Student's Name ______________________________ |
| Classroom Teacher ______________________________ Grade/Letter __________________ |
| Family Address ___________________________________ Daytime Telephone # ___________________ |
| _____________________________________________ | Evening Telephone # ______________________ |
| | | | | | | | |
| Delivery Type: ______Backpack ______Parent Pickup ______Other | |
| | | | | | | | |
| Merchant/Store | | Amount | | Committee Use Only |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| | | | | Total $ __________________ | |
| Payment Type Cash ______ Ck # _____________ Please make out check to: |
| Resurrection Catholic School (RCS) |
| Please indicate if Scrip is to be credited to someone other than purchasing family. | |
| | | | | | | | |
| Family Name _______________________ | School Fund _____________________________ |
| Grd./Letter _______________________ | | | | |
| | | | | | | | | |
|
|
|
|
|
|
| | |
| Cust. # _______________________ | | Date _____/_____/_____ | |
| Parent's Name ____________________________ Student's Name ______________________________ |
| Classroom Teacher ______________________________ Grade/Letter __________________ |
| Family Address ___________________________________ Daytime Telephone # ___________________ |
| _____________________________________________ | Evening Telephone # ______________________ |
| | | | | | | | |
| Delivery Type: ______Backpack ______Parent Pickup ______Other | |
| Merchant/Store | | Amount | | Committee Use Only |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| ________________________ | ________________________ | _________________________________ |
| | | | | Total $ __________________ | |
| | | | | | | | |
| Payment Type Cash ______ Ck # _____________ Please make out check to: |
| Resurrection Catholic School (RCS) |
| Please indicate if Scrip is to be credited to someone other than purchasing family. | |
| | | | | | | | |
| Family Name _______________________ | School Fund _____________________________ |
| Grd./Letter _______________________ |
