Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Employee Name *Location *Choose OneMuskegonCoopersvilleGrandvilleLowellBig RapidsAdditional LocationsMuskegon *Choose OneChevy Service B-2748 (1399)Chevy Parts B-2897 (1761)Chevy Body Shop B-261 (22253)Chevy New Cars B-2995 (1758)Honda Service B-2202 (3177)Honda Used Cars B-2255 (2593)Honda New Cars B-2552 (2592)Hyundai B-2307 (2596)Coopersville *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 OneHudsonville J-3825 (5598)Allegan C-2689 (4657)Ludington R-1847 (4681)Cadillac R-2887 (4794)Alma R-4712 (4825)Ithaca R-4710 (4826)Midland R-3841 (4907)South Haven P-2411 (5035)Reason for Request *Choose OneNew EmployeeCurrent EmployeeTermination (Out)TransferOrder Type *Choose OneRental PurchaseRental Shirt Style *MensLadiesSleeve Length *Short Sleeve OnlyLong Sleeve OnlyMix of Short Sleeve & Long SleeveShirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLLTXLT2XLT3XLT4XLTShirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLLayoutShirt 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 - BothLayout (copy)Quantity of Royal Short Sleeve *Quantity of Black Short Sleeve *Choose Long Sleeve Shirt Style *Edwards Dress Shirt - E-1975Cornerstone CS418LS - RoyalCornerstone CS418LS - BlackLayoutQuantity 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 - BlackLayout (copy)Quantity 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 - BlackLayout (copy) (copy)Quantity 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 - BlackLayout (copy)Quantity 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.Employee Signature *Clear SignatureDate *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 OneXXSXSSmallMediumLargeXL 2XL3XLCornerstone 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 *DateDateEmployee Signature *Clear SignatureDate *Transfer from *Choose OneMuskegonCoopersvilleGrandvilleLowellBig RapidsMuskegon *Choose OneChevy Service B-2748Chevy Parts B-2897Chevy Body Shop B-261Chevy New Cars B-2995Honda Service B-2202Honda Used Cars B-2255Honda New Cars B-2552Hyundai B-2307Coopersville *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 RapidsMuskegon *Choose OneChevy Service B-2748Chevy Parts B-2897Chevy Body Shop B-261Chevy New Cars B-2995Honda Service B-2202Honda Used Cars B-2255Honda New Cars B-2552Hyundai B-2307Coopersville *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-4170NameSubmit