Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Employee Name *Location *Choose OneCoopersvilleGrandvilleLowellBig RapidsAdditional LocationsCoopersville *Choose OneService J-1714 (556)Parts J-1690 (557)Body Shop J-1723 (558)New Cars J-1751 (2597)Used Cars J-1851 (2603)CDJR J-1048 (4862)Ford J-1887 (5087)Grandville *Choose OneUsed Cars & Service F-5170 (4366)Buick Collision F-5862 (4526)Lowell *Choose OneBuick GMC Q-4058 (4367)GMC Collision Q-4652 (4509)CDJR Q-4170 (4368)Big Rapids *Choose OneBig Rapids R-2498 (4484)Big Rapids CDJR R-2412 (4944)Additional Locations *Choose OneAlma R-4712 (4825)Allegan C-2689 (4657)Cadillac R-2887 (4794)Hudsonville J-3825 (5598)Ithaca R-4710 (4826)Ludington R-1847 (4681)Midland R-3841 (4907)South Haven P-2411 (5035)Reason for Request *Choose OneNew EmployeeCurrent EmployeeTermination (Out)TransferOrder Type *Choose OneRentalPurchaseRental Shirt Style *MensLadiesSleeve Length *Short Sleeve OnlyLong Sleeve OnlyMix of Short Sleeve & Long SleeveShirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLLTXLT2XLT3XLT4XLTShirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLShirt Size for Short Sleeve *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLLTXLT2XLT3XLT4XLT*Tall sizes are only available in short sleeve stylesShirt Size for Long Sleeve *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLChoose Black, Royal or Both *Sport-Tek TST650 - BlackSport-Tek TST650 - RoyalSport-Tek TST650 - BothChoose Black, Royal or Both *Cornerstone CS418 - BlackCornerstone CS418 - RoyalCornerstone CS418 - BothQuantity of Royal Short Sleeve *Quantity of Black Short Sleeve *Choose Long Sleeve Shirt Style *Edwards Dress Shirt - E-1975Cornerstone CS418LS - RoyalCornerstone CS418LS - BlackQuantity of E-1975 *Quantity of CS418LS - Royal *Quantity of CS418LS -Black *Total of all long sleeve shirts should equal 11Choose Shirt Styles *Edwards Dress Shirt - E-1975Cornerstone CS418LS - RoyalCornerstone CS418LS - Black *Sport-Tek TST650 - RoyalSport-Tek TST650 - Black *Cornerstone CS418 - RoyalCornerstone CS418 - BlackQuantity of E-1975 *Quantity of TST650 - Royal *Quantity CS418 - Royal *Quantity of CS418LS - Royal *Quantity of TST650 - Black *Quantity of CS418 - Black *Quantity of CS418LS -Black *Total of all shirts should equal 11Choose Black, Royal or Both *Cornerstone CS419 - BlackCornerstone CS419 - RoyalCornerstone CS419 - BothChoose Long Sleeve Shirt Style *Edwards Dress Shirt - E-5975Cornerstone CS418LS - RoyalCornerstone CS418LS - BlackQuantity of E-5975 *Quantity of CS418LS - Royal *Quantity of CS418LS - Black *Choose Shirt Styles *Cornerstone CS419 - BlackCornerstone CS419 - RoyalEdwards Dress Shirt - E-5975Cornerstone CS418LS - RoyalCornerstone CS418LS - BlackQuantity CS419 - Black *Quantity CS418LS - Royal *Quantity of CS419 - Royal *Quantity of CS418LS - Black *Quantity of E-5975 *Total of all shirts should equal 11Statement of Rental ResponsibilityI would like to rent 11 shirts for $6.00/week and know that the shirts are the property of WM Uniform. I will return WM Uniform's property upon cancellation of my rental service. I agree to the weekly rental charge that will be deducted from my check. I understand that the rental program includes the laundering and pressing of my uniform shirts and what I turn in will be returned the next scheduled delivery.Date *Purchase Shirt Style *MensLadiesProduct Type (Select All That Apply) *Polo ShirtQuarter-Zip FleeceVestLong Sleeve ShirtPolo Shirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLLTXLT2XLT3XLT4XLTPolo Shirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLPolo Shirt Color & Style Selection (Select All That Apply) *Cornerstone CS418 - BlackCornerstone CS418 - RoyalOGIO OG125 - BlacktopOGIO OG125 - Bolt BluePolo Shirt Color & Style Selection (Select All That Apply) *Sport-Tek TST650 - BlackSport-Tek TST650 - RoyalQuarter-Zip Fleece Color & Style Selection (Select All That Apply) *Sport-Tek ST561 - BlackSport-Tek ST561 - RoyalThe North Face NF0A3LHB - TNF BlackThe North Face NF0A3LHB - Monster BlueOGIO Endurance OE335 - BlacktopOGIO Endurance OE335 - Electric BlueVest Selection *The North Face NF0A3LGZ - TNF BlackLong Sleeve Shirt Color & Style Selection (Select All That Apply) *Edwards Dress Shirt - E-1975Cornerstone CS418LS - RoyalCornerstone CS418LS - BlackPolo Shirt Color & Style Selection (Select All That Apply) *Cornerstone CS419 - BlackCornerstone CS419 - RoyalOGIO LOG125 - BlacktopOGIO LOG125 - Bolt BlueQuarter-Zip Fleece Color & Style Selection (Select All That Apply) *Sport-Tek LST561 - BlackSport-Tek LST561 - RoyalThe North Face NF0A3LHC - TNF BlackThe North Face NF0A3LHC - Monster BlueOGIO Endurance LOE335 - BlacktopVest Selection *The North Face NF0A3LH1 - TNF BlackLong Sleeve Shirt Color & Style Selection (Select All That Apply) *Edwards Dress Shirt - E-5975Cornerstone CS418LS - RoyalCornerstone CS418LS - BlackSport-Tek Quarter-Zip Fleece Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLOGIO Endurance Quarter-Zip Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLThe North Face Quarter-Zip Fleece Size *Choose OneSmallMediumLargeXL2XL3XLThe North Face Vest Size *Choose OneSmallMediumLargeXL2XL3XLThe North Face Quarter-Zip Fleece Size *Choose OneSmallMediumLargeXL2XLThe North Face Vest Size *Choose OneSmallMediumLargeXL2XLEdwards Dress Shirt Size *Choose OneSmallMediumLargeLarge TallXLXL Tall2XL2XL Tall3XL3XL Tall4XL Tall5XL Tall6XL TallEdwards Dress Shirt Size *Choose OneXXSXSSmallMediumLargeXL2XL3XLCornerstone Long Sleeve Polo Size *Choose OneXSSmallMediumLargeXL2XL3XL4XLQuantity Needed - Cornerstone CS418 Black (XS-XL) *Select Quantity1 - $18.682 - $37.363 - $56.044 - $74.725 - $93.40Quantity Needed - Cornerstone CS418 Black (2XL) *Select Quantity1 - $20.382 - $40.763 - $61.144 - $81.525 - $101.90Quantity Needed - Cornerstone CS418 Black (3XL) *Select Quantity1 - $23.782 - $47.563 - $71.344 - $95.125 - $118.90Quantity Needed - Cornerstone CS418 Black (4XL) *Select Quantity1 - $25.482 - $50.963 - $76.444 - $101.925 - $127.40Quantity Needed - Cornerstone CS418 Royal (XS-XL) *Select Quantity1 - $18.682 - $37.363 - $56.044 - $74.725 - $93.40Quantity Needed - Cornerstone CS418 Royal (2XL) *Select Quantity1 - $20.382 - $40.763 - $61.144 - $81.525 - $101.90Quantity Needed - Cornerstone CS418 Royal (3XL) *Select Quantity1 - $23.782 - $47.563 - $71.344 - $95.125 - $118.90Quantity Needed - Cornerstone CS418 Royal (4XL) *Select Quantity1 - $25.482 - $50.963 - $76.444 - $101.925 - $127.40Quantity Needed - OGIO OG125 Blacktop (XS-XL) *Select Quantity1 - $30.602 - $61.203 - $91.804 - $122.405 - $153.00Quantity Needed - OGIO OG125 Blacktop (2XL) *Select Quantity1 - $32.302 - $64.603 - $96.904 - $129.205 - $161.50Quantity Needed - OGIO OG125 Blacktop (3XL) *Select Quantity1 - $35.702 - $71.403 - $107.104 - $142.805 - $178.50Quantity Needed - OGIO OG125 Blacktop (4XL) *Select Quantity1 - $37.402 - $74.803 - $112.204 - $149.605 - $187.00Quantity Needed - OGIO OG125 Bolt Blue (XS-XL) *Select Quantity1 - $30.602 - $61.203 - $91.804 - $122.405 - $153.00Quantity Needed - OGIO OG125 Bolt Blue (2XL) *Select Quantity1 - $32.302 - $64.603 - $96.904 - $129.205 - $161.50Quantity Needed - OGIO OG125 Bolt Blue (3XL) *Select Quantity1 - $35.702 - $71.403 - $107.104 - $142.805 - $178.50Quantity Needed - OGIO OG125 Bolt Blue (4XL) *Select Quantity1 - $37.402 - $74.803 - $112.204 - $149.605 - $187.00Quantity Needed - Cornerstone CS419 Black (XS-XL) *Select Quantity1 - $18.682 - $37.363 - $56.044 - $74.725 - $93.40Quantity Needed - Cornerstone CS419 Black (2XL) *Select Quantity1 - $20.382 - $40.763 - $61.144 - $81.525 - $101.90Quantity Needed - Cornerstone CS419 Black (3XL) *Select Quantity1 - $23.782 - $47.563 - $71.344 - $95.125 - $118.90Quantity Needed - Cornerstone CS419 Black (4XL) *Select Quantity1 - $25.482 - $50.963 - $76.444 - $101.925 - $127.40Quantity Needed - Cornerstone CS419 Royal (XS-XL) *Select Quantity1 - $18.682 - $37.363 - $56.044 - $74.725 - $93.40Quantity Needed - Cornerstone CS419 Royal (2XL) *Select Quantity1 - $20.382 - $40.763 - $61.144 - $81.525 - $101.90Quantity Needed - Cornerstone CS419 Royal (3XL) *Select Quantity1 - $23.782 - $47.563 - $71.344 - $95.125 - $118.90Quantity Needed - Cornerstone CS419 Royal (4XL) *Select Quantity1 - $25.482 - $50.963 - $76.444 - $101.925 - $127.40Quantity Needed - OGIO LOG125 Blacktop (XS-XL) *Select Quantity1 - $30.602 - $61.203 - $91.804 - $122.405 - $153.00Quantity Needed - OGIO LOG125 Blacktop (2XL) *Select Quantity1 - $32.302 - $64.603 - $96.904 - $129.205 - $161.50Quantity Needed - OGIO LOG125 Blacktop (3XL) *Select Quantity1 - $35.702 - $71.403 - $107.104 - $142.805 - $178.50Quantity Needed - OGIO LOG125 Blacktop (4XL) *Select Quantity1 - $37.402 - $74.803 - $112.204 - $149.605 - $187.00Quantity Needed - OGIO LOG125 Bolt Blue (XS-XL) *Select Quantity1 - $30.602 - $61.203 - $91.804 - $122.405 - $153.00Quantity Needed - OGIO LOG125 Bolt Blue (2XL) *Select Quantity1 - $32.302 - $64.603 - $96.904 - $129.205 - $161.50Quantity Needed - OGIO LOG125 Bolt Blue (3XL) *Select Quantity1 - $35.702 - $71.403 - $107.104 - $142.805 - $178.50Quantity Needed - OGIO LOG125 Bolt Blue (4XL) *Select Quantity1 - $37.402 - $74.803 - $112.204 - $149.605 - $187.00Quantity Needed - Sport-Tek TST650 Black (LT) *Select Quantity1 - $20.762 - $41.523 - $62.284 - $83.045 - $103.80Quantity Needed - Sport-Tek TST650 Black (XLT) *Select Quantity1 - $22.462 - $44.923 - $67.384 - $89.845 - $112.30Quantity Needed - Sport-Tek TST650 Black (2XLT) *Select Quantity1 - $24.162 - $48.323 - $72.484 - $96.645 - $120.80Quantity Needed - Sport-Tek TST650 Black (3XLT) *Select Quantity1 - $25.862 - $51.723 - $77.584 - $103.445 - $129.30Quantity Needed - Sport-Tek TST650 Black (4XLT) *Select Quantity1 - $27.562 - $55.123 - $82.684 - $110.245 - $137.80Quantity Needed - Sport-Tek TST650 Royal (LT) *Select Quantity1 - $20.762 - $41.523 - $62.284 - $83.045 - $103.80Quantity Needed - Sport-Tek TST650 Royal (XLT) *Select Quantity1 - $22.462 - $44.923 - $67.384 - $89.845 - $112.30Quantity Needed - Sport-Tek TST650 Royal (2XLT) *Select Quantity1 - $24.162 - $48.323 - $72.484 - $96.645 - $120.80Quantity Needed - Sport-Tek TST650 Royal (3XLT) *Select Quantity1 - $25.862 - $51.723 - $77.584 - $103.445 - $129.30Quantity Needed - Sport-Tek TST650 Royal (4XLT) *Select Quantity1 - $27.562 - $55.123 - $82.684 - $110.245 - $137.80Quantity Needed - Sport-Tek ST561 Black (XS-XL) *Select Quantity1 - $30.582 - $61.163 - $91.744 - $122.325 - $152.90Quantity Needed - Sport-Tek ST561 Black (2XL) *Select Quantity1 - $32.282 - $64.563 - $96.844 - $129.125 - $161.40Quantity Needed - Sport-Tek ST561 Black (3XL) *Select Quantity1 - $35.682 - $71.363 - $107.044 - $142.725 - $178.40Quantity Needed - Sport-Tek ST561 Black (4XL) *Select Quantity1 - $37.382 - $74.763 - $112.144 - $149.525 - $186.90Quantity Needed - Sport-Tek ST561 Royal (XS-XL) *Select Quantity1 - $30.582 - $61.163 - $91.744 - $122.325 - $152.90Quantity Needed - Sport-Tek ST561 Royal (2XL) *Select Quantity1 - $32.282 - $64.563 - $96.844 - $129.125 - $161.40Quantity Needed - Sport-Tek ST561 Royal (3XL) *Select Quantity1 - $35.682 - $71.363 - $107.044 - $142.725 - $178.40Quantity Needed - Sport-Tek ST561 Royal (4XL) *Select Quantity1 - $37.382 - $74.763 - $112.144 - $149.525 - $186.90Quantity Needed - Sport-Tek LST561 Black (XS-XL) *Select Quantity1 - $30.582 - $61.163 - $91.744 - $122.325 - $152.90Quantity Needed - Sport-Tek LST561 Black (2XL) *Select Quantity1 - $32.282 - $64.563 - $96.844 - $129.125 - $161.40Quantity Needed - Sport-Tek LST561 Black (3XL) *Select Quantity1 - $35.682 - $71.363 - $107.044 - $142.725 - $178.40Quantity Needed - Sport-Tek LST561 Black (4XL) *Select Quantity1 - $37.382 - $74.763 - $112.144 - $149.525 - $186.90Quantity Needed - Sport-Tek LST561 Royal (XS-XL) *Select Quantity1 - $30.582 - $61.163 - $91.744 - $122.325 - $152.90Quantity Needed - Sport-Tek LST561 Royal (2XL) *Select Quantity1 - $32.282 - $64.563 - $96.844 - $129.125 - $161.40Quantity Needed - Sport-Tek LST561 Royal (3XL) *Select Quantity1 - $35.682 - $71.363 - $107.044 - $142.725 - $178.40Quantity Needed - Sport-Tek LST561 Royal (4XL) *Select Quantity1 - $37.382 - $74.763 - $112.144 - $149.525 - $186.90Quantity Needed - The North Face NF0A3LHB TNF Black (S-XL) *Select Quantity1 - $61.502 - $123.003 - $184.504 - $246.005 - $307.50Quantity Needed - The North Face NF0A3LHB TNF Black (2XL) *Select Quantity1 - $63.172 - $126.343 - $189.514 - $252.685 - $315.85Quantity Needed - The North Face NF0A3LHB TNF Black (3XL) *Select Quantity1 - $66.502 - $133.003 - $199.504 - $266.005 - $332.50Quantity Needed - The North Face NF0A3LHB Monster Blue (S-XL) *Select Quantity1 - $61.502 - $123.003 - $184.504 - $246.005 - $307.50Quantity Needed - The North Face NF0A3LHB Monster Blue (2XL) *Select Quantity1 - $63.172 - $126.343 - $189.514 - $252.685 - $315.85Quantity Needed - The North Face NF0A3LHB Monster Blue (3XL) *Select Quantity1 - $66.502 - $133.003 - $199.504 - $266.005 - $332.50Quantity Needed - The North Face NF0A3LHC TNF Black (S-XL) *Select Quantity1 - $61.502 - $123.003 - $184.504 - $246.005 - $307.50Quantity Needed - The North Face NF0A3LHC TNF Black (2XL) *Select Quantity1 - $63.172 - $126.343 - $189.514 - $252.685 - $315.85Quantity Needed - The North Face NF0A3LHC Monster Blue (S-XL) *Select Quantity1 - $61.502 - $123.003 - $184.504 - $246.005 - $307.50Quantity Needed - The North Face NF0A3LHC Monster Blue (2XL) *Select Quantity1 - $63.172 - $126.343 - $189.514 - $252.685 - $315.85Quantity Needed - OGIO Endurance OE335 Blacktop (XS-XL) *Select Quantity1 - $37.402 - $74.803 - $112.204 - $149.605 - $187.00Quantity Needed - OGIO Endurance OE335 Electric Blue (XS-XL) *Select Quantity1 - $37.402 - $74.803 - $112.204 - $149.605 - $187.00Quantity Needed - OGIO Endurance LOE335 Blacktop (XS-XL) *Select Quantity1 - $37.402 - $74.803 - $112.204 - $149.605 - $187.00Quantity Needed - OGIO Endurance OE335 Blacktop (2XL) *Select Quantity1 - $39.102 - $78.203 - $117.304 - $156.405 - $195.50Quantity Needed - OGIO Endurance OE335 Electric Blue (2XL) *Select Quantity1 - $39.102 - $78.203 - $117.304 - $156.405 - $195.50Quantity Needed - OGIO Endurance LOE335 Blacktop (2XL) *Select Quantity1 - $39.102 - $78.203 - $117.304 - $156.405 - $195.50Quantity Needed - OGIO Endurance OE335 Blacktop (3XL) *Select Quantity1 - $42.502 - $85.003 - $127.504 - $170.005 - $212.50Quantity Needed - OGIO Endurance OE335 Electric Blue (3XL) *Select Quantity1 - $42.502 - $85.003 - $127.504 - $170.005 - $212.50Quantity Needed - OGIO Endurance LOE335 Blacktop (3XL) *Select Quantity1 - $42.502 - $85.003 - $127.504 - $170.005 - $212.50Quantity Needed - OGIO Endurance OE335 Blacktop (4XL) *Select Quantity1 - $44.202 - $88.403 - $132.604 - $176.805 - $221.00Quantity Needed - OGIO Endurance OE335 Electric Blue (4XL) *Select Quantity1 - $44.202 - $88.403 - $132.604 - $176.805 - $221.00Quantity Needed - OGIO Endurance LOE335 Blacktop (4XL) *Select Quantity1 - $44.202 - $88.403 - $132.604 - $176.805 - $221.00Quantity Needed - The North Face NF0A3LGZ TNF Black (S-XL) *Select Quantity1 - $86.702 - $173.403 - $260.104 - $346.805 - $433.50Quantity Needed - The North Face NF0A3LGZ TNF Black (2XL) *Select Quantity1 - $88.372 - $176.743 - $265.114 - $353.485 - $441.85Quantity Needed - The North Face NF0A3LGZ TNF Black (3XL) *Select Quantity1 - $91.702 - $183.403 - $275.104 - $366.805 - $458.50Quantity Needed - The North Face NF0ALH1 TNF Black (S-XL) *Select Quantity1 - $86.702 - $173.403 - $260.104 - $346.805 - $433.50Quantity Needed - The North Face NF0ALH1 TNF Black (2XL) *Select Quantity1 - $88.372 - $176.743 - $265.114 - $353.485 - $441.85Quantity Needed - Cornerstone CS418LS Royal (XS-XL) *Select Quantity1 - $27.982 - $55.963 - $83.944 - $111.925 - $139.90Quantity Needed - Cornerstone CS418LS Royal (2XL) *Select Quantity1 - $29.982 - $59.963 - $89.944 - $119.925 - $149.90Quantity Needed - Cornerstone CS418LS Royal (3XL) *Select Quantity1 - $33.982 - $67.963 - $101.944 - $135.925 - $169.90Quantity Needed - Cornerstone CS418LS Royal (4XL) *Select Quantity1 - $35.982 - $71.963 - $107.944 - $143.925 - $179.90Quantity Needed - Cornerstone CS418LS Black (XS-XL) *Select Quantity1 - $27.982 - $55.963 - $83.944 - $111.925 - $139.90Quantity Needed - Cornerstone CS418LS Black (2XL) *Select Quantity1 - $29.982 - $59.963 - $89.944 - $119.925 - $149.90Quantity Needed - Cornerstone CS418LS Black (3XL) *Select Quantity1 - $33.982 - $67.963 - $101.944 - $135.925 - $169.90Quantity Needed - Cornerstone CS418LS Black (4XL) *Select Quantity1 - $35.982 - $71.963 - $107.944 - $143.925 - $179.90Quantity Needed - Edwards Dress Shirt E-1975 (S-XL) *Select Quantity1 - $35.002 - $70.003 - $105.004 - $140.005 - $175.00Quantity Needed - Edwards Dress Shirt E-1975 (LT, XLT, 2XL, 2XLT) *Select Quantity1 - $42.002 - $84.003 - $126.004 - $168.005 - $210.00Quantity Needed - Edwards Dress Shirt E-1975 (3XL, 3XLT, 4XLT) *Select Quantity1 - $45.502 - $91.003 - $136.504 - $182.005 - $227.50Quantity Needed - Edwards Dress Shirt E-1975 (5XLT, 6XLT) *Select Quantity1 - $52.502 - $105.003 - $157.504 - $210.005 - $262.50Quantity Needed - Edwards Dress Shirt E-5975 (XXS-XL) *Select Quantity1 - $35.002 - $70.003 - $105.004 - $140.005 - $175.00Quantity Needed - Edwards Dress Shirt E-5975 (2XL) *Select Quantity1 - $46.802 - $93.603 - $140.404 - $187.205 - $234.00Quantity Needed - Edwards Dress Shirt E-5975 (3XL) *Select Quantity1 - $50.702 - $101.403 - $152.104 - $202.805 - $253.50Total$0.00Statement of Purchase Responsibility I understand that I am indebted to Betten Baker Auto Group for the above amount for the purchase of uniforms. *I authorize Betten Baker to deduct this amount from my next paycheck (Date Selected Below)I agree to pay Betten Baker the amount below on the dates listed belowDate *Amount Paid *Date *DateDateDate *Transfer from *Choose OneMuskegonCoopersvilleGrandvilleLowellBig RapidsCoopersville *Choose OneService J-1714Parts J-1690Body Shop J-1723Chevy New Cars B-2995New Cars J-1751Used Cars J-1851GCDJ J-1048Ford J-1887Grandville *Choose OneBuick F-5170Buick Collision F-5862Lowell *Choose OneWittenbach Q-4058GMC Collision Q-4652GCDJ Q-4170Big Rapids *Choose OneBig Rapids R-2498Big Rapids CDJR R-2498Hudsonville J-3825Allegan C-2689Ludington R-1847Cadillac R-2887Alma R-4712Ithica R-4710Midland R-3841South Haven P-2411Transfer to *Choose OneMuskegonCoopersvilleGrandvilleLowellBig RapidsCoopersville *Choose OneService J-1714Parts J-1690Body Shop J-1723Chevy New Cars B-2995New Cars J-1751Used Cars J-1851GCDJ J-1048Ford J-1887Grandville *Choose OneBuick F-5170Buick Collision F-5862Lowell *Choose OneWittenbach Q-4058GMC Collision Q-4652GCDJ Q-4170MessageSubmit