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School YTD earnings: $3,746.58 |
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| ENROLLMENT FORM | |||||
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| St.
George School 133 W. 4th Street Hermann, MO 65041 Phone: 573-486-5914 Fax: 573-486-1914 |
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St. George School SCRIP |
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| Date: ___________________ | |||||
| Business Name: ______________________________________________________________________ | |||||
| Address: ____________________________________________________________________________ | |||||
| Phone Number: _______________________________________________________________________ | |||||
| Fax Number: _________________________________________________________________________ | |||||
| Contact Person: ______________________________________________________________________ | |||||
| Percentage Discount: _________________________________________________________________ | |||||
| Exclusions (if any) on certificates: (i.e. not in combination w/a sale or No change given) | |||||
| _____________________________________________________________________________________ | |||||
| _____________________________________________________________________________________ | |||||
| _____________________________________________________________________________________ | |||||
| Denominations of certificates: ___________________________________________ | |||||
| When/Where to pick-up certificates: | |||||
| _____________________________________________________________________________________ | |||||
| _____________________________________________________________________________________ | |||||
| ______________________________________ ______________________________________ | |||||
| Signature Print Name | |||||
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Thank You for participating without school SCRIP Program! |
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Please contact the school should you every have any questions. |
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