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ST. MICHAEL SCRIP ORDER FORM

Please complete the form below and submit to Pat Lenne by Thursday at 5 p.m.

Name First Last
Phone ### - ### - ####
List Retail SCRIP/Cost/Quantity/Total for Each Item
Date MM / DD / YYYY
Order Total $ Dollars . Cents
Check # or Cash
Student Name
Family #
Will Pick Up Order After the Following Weekend Mass:
5 p.m. 7:30 a.m. 9:30 a.m. 11:30 a.m.
Do Not Fill This Out

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