H

Date:
Name:
Sycamore #:
Phone:
Parish:

I will pick up my certificates at School office_____ Rectory _____ Weekend Mass_____

I accept responsibility for my child (name)______________________ (room #)________ to deliver these HOPE certificates to me from school.

Signed:___________________________________________________________________________

Retailer	Profit	Denom.	Order Amt.	Retailer	Profit	Denom.	Order Amt.
Applebee’s	8%	$25		JCPenney	5%	$25
Arby’s	8%	$10		*JCPenney	5%	$100
Bag N' Save	2%	$10		Kentucky Fried Chicken	8%	$5
*Bag N' Save	2%	$25		Kohls	5%	$25
*Bag N' Save	2%	$50		*Kohls	5%	$50
*COUPON BK (unavailable)	60%	$5		*Kohls	5%	$100
Bakers	5%	$10		Lowe's	4%	$25
*Bakers	5%	$25		*Lowe's	4%	$100
*Bakers	5%	$50		Marcus/Douglas Theatres	9%	$25
Bath & Body Works	13%	$10		Menards	3%	$25
Best Buy	3%	$25		*Menards	3%	$100
Blimpies	5%	$25		Old Chicago	10%	$25
Blockbuster Video	7%	$10		Olive Garden/Red Lobster	9%	$25
				Outback/Carrabas/Flemings	8%	$25
Burger King	4%	$10		Panera Bread	9%	$10
Carrabas/Outback/Flemings	8%	$25		Pizza Hut	8%	$10
Dennis Uniform	5%	$20		Red Robin	9%	$25
Famous Daves BBQ	10%	$10		Romeo's	10%	$10
Fernando's	20%	$10		Runza	10%	$10
Gap/OldNavy/B. Republic	9%	$25		Shopko	3%	$25
Gloria Deo	5%	$20		Starbucks	7%	$10
Godfathers	10%	$25		Subway	3%	$10
Granite City	10%	$25		Toys R Us/Kids R Us	1.5%	$20
Hollywood Diner	5%	$10		Valentino's	9%	$5
Home Depot	4%	$25		Walgreen's	6%	$25
*Home Depot	4%	$100		Walmart/Sam's Club	2%	$25
HyVee Coupon Book	60%	$5		*Walmart/Sam's Club	4%	$100
				Wendy's	4%	$10

* available in multiple denominations

PRE-ORDER ONLY

PRE-ORDER ONLY				PRE-ORDER ONLY
Retailer	Profit	Denom.	Order Amt.	Retailer	Profit	Denom.	Order Amt.
AMC Theater (Oakview 24)	7%	$25		Guaranteed Clean	10%
Ace Hardware	4%	$25		Honey Baked Hams	12%	$10
Advanced Auto Parts	7%	$25		Hyatt Hotels	9%	$50
Amazon.com	4%	$25		iTunes	5%	$15
American Airlines	8%	$100		JoAnn Fabrics	6%	$20
American Eagle	10%	$25		K Mart	4%	$25
AT&T 125 Minute Card	20%	$9.50		Land's End	16%	$25
Barnes & Noble	9%	$10		Lane Bryant/Fashion Bug	6%	$25
*Barnes & Noble	9%	$25		Laura's Homemade Foods	10%	$10
BassPro Shops	9%	$25		Limited	9%	$25
Bed Bath & Beyond	7%	$25		Long John Silvers	8%	$5
Boston Market	12%	$10		Marriott Hotels/Rennaissance
BP Gas	1.5%	$50		Fairfield, Courtyard, & Residence	8%	$50
Brueggers Bagels	7%	$10		Marshalls/TJ Maxx	7%	$25
Build-a-Bear Workshops	8%	$25		Men's Wearhouse	8%	$25
Cabela's	11%	$25		Michael's	4%	$25
California Pizza Kitchen	4%	$10		Mimi's Cafe	8%	$25
Carlos O'Kellys	9%	$10		Office Depot	4%	$25
Carnival Cruises	8%	$100		Office Max	5%	$25
Cheesecake Factory	5%	$25		Old Country Buffet	5%	$25
Cheesecakes by Karen	10%	$10		Omaha Steaks	11%	$25
Childrens Place	12%	$25		Overstock.com	8%	$25
Chipotle Mexican Grill	10%	$10		PF Changs	8%	$25
Chuck E. Cheese	8%	$10		Papa Johns	8%	$10
Claire's/Icing	9%	$10		Payless Shoes	13%	$20
Cold Stone Creamery	8%	$10		Pet Smart	4%	$25
Cracker Barrel	9%	$10		Pier 1 Imports	9%	$25
Crate and Barrel	8%	$25		Pottery Barn/William Sonoma	8%	$25
CVS Pharmacy	6%	$25		Qdoba	7%	$25
Dave & Busters	6%	$25		Radio Shack	4%	$25
Dick's sporting Goods	8%	$25		Ruby Tuesdays	8%	$25
Dillards	9%	$25		Sally's Beauty Supply	12%	$25
Domino's Pizza	8%	$10		Sears	4%	$25
Dress Barn	8%	$25		Shell Gas	2.5%	$25
EB Games/Game Stop	3%	$25		*Shell Gas	2.5%	$100
Eddie Bauer	10%	$25		Shoe Carnival	5%	$25
Express	13%	$25		Sinclair Oil	1.5%	$25
Family Video	12%	$10		Sports Authority	8%	$25
Fazoli's	7%	$25		Staples	5%	$25
Footlocker	9%	$25		tailgategames.net	10%
GNC	8%	$25		Talbot's	13%	$25
Gordman's	7%	$25		TGIFridays	9%	$25
Great Clilps	8%	$25		Texas Roadhouse	8%	$25
Great Harvest Bread Co.	8%	$10		Younkers	8%	$25

* available in multiple denominations TOTAL ORDER AMOUNT $_________________________________