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 *MensLadiesShirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLLTXLT2XLT3XLT4XLTShirt Size *Choose OneX-SmallSmallMediumLargeXL2XL3XL4XLChoose Black, Royal or Both *Cornerstone CS418 - BlackCornerstone CS418 - RoyalCornerstone CS418 - BothChoose Black, Royal or Both *Sport-Tek TST650 - BlackSport-Tek TST650 - RoyalSport-Tek TST650 - BothChoose Black, Royal or Both *Cornerstone CS419 - BlackCornerstone CS419 - RoyalCornerstone CS419 - BothStatement of Rental ResponsibilityI would like to rent 11 Cornerstone 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 FleeceVestPolo 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 BluePolo 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 NF0A5542 - TNF BlackVest Selection *The North Face NF0A5543 - TNF 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 OneSmallMediumLargeXL2XLQuantity Needed - Cornerstone CS418 Black (XS-XL) *Select Quantity1 - $ 17.322 - $ 34.643 - $ 51.964 - $ 69.285 - $ 86.60Quantity Needed - Cornerstone CS418 Black (2XL-4XL) *Select Quantity1 - $ 21.952 - $ 43.903 - $ 65.854 - $ 87.805 - $ 109.75Quantity Needed - Cornerstone CS418 Royal (XS-XL) *Select Quantity1 - $ 17.322 - $ 34.643 - $ 51.964 - $ 69.285 - $ 86.60Quantity Needed - Cornerstone CS418 Royal (2XL-4XL) *Select Quantity1 - $ 21.952 - $ 43.903 - $ 65.854 - $ 87.805 - $ 109.75Quantity Needed - OGIO OG125 Blacktop (XS-XL) *Select Quantity1 - $ 29.752 - $ 59.503 - $ 89.254 - $ 119.005 - $ 148.75Quantity Needed - Ogio OG125 Blacktop (2XL-4XL) *Select Quantity1 - $ 33.132 - $ 66.263 - $ 99.394 - $ 132.525 - $ 165.65Quantity Needed - OGIO OG125 Bolt Blue (XS-XL) *Select Quantity1 - $ 29.752 - $ 59.503 - $ 89.254 - $ 119.005 - $ 148.75Quantity Needed - OGIO OG125 Bolt Blue (2XL-4XL) *Select Quantity1 - $ 33.132 - $ 66.263 - $ 99.394 - $ 132.525 - $ 165.65Quantity Needed - Cornerstone CS419 Black (XS-XL) *Select Quantity1 - $ 17.322 - $ 34.643 - $ 51.964 - $ 69.285 - $ 86.60Quantity Needed - Cornerstone CS419 Black (2XL-4XL) *Select Quantity1 - $ 21.952 - $ 43.903 - $ 65.854 - $ 87.805 - $ 109.75Quantity Needed - Cornerstone CS419 Royal (XS-XL) *Select Quantity1 - $ 17.322 - $ 34.643 - $ 51.964 - $ 69.285 - $ 86.60Quantity Needed - Cornerstone CS419 Royal (2XL-4XL) *Select Quantity1 - $ 21.952 - $ 43.903 - $ 65.854 - $ 87.805 - $ 109.75Quantity Needed - OGIO LOG125 Blacktop (XS-XL) *Select Quantity1 - $ 29.752 - $ 59.503 - $ 89.254 - $ 119.005 - $ 148.75Quantity Needed - OGIO LOG125 Blacktop (2XL-4XL) *Select Quantity1 - $ 33.132 - $ 66.263 - $ 99.394 - $ 132.525 - $ 165.65Quantity Needed - OGIO LOG125 Bolt Blue (XS-XL) *Select Quantity1 - $ 29.752 - $ 59.503 - $ 89.254 - $ 119.005 - $ 148.75Quantity Needed - OGIO LOG125 Bolt Blue (2XL-4XL) *Select Quantity1 - $ 33.132 - $ 66.263 - $ 99.394 - $ 132.525 - $ 165.65Quantity Needed - Sport-Tek TST650 Black (LT-4XLT) *Select Quantity1 - $ 23.232 - $ 46.463 - $ 69.694 - $ 92.925 - $ 116.15Quantity Needed - Sport-Tek TST650 Royal (LT-4XLT) *Select Quantity1 - $ 23.232 - $ 46.463 - $ 69.694 - $ 92.925 - $ 116.15Quantity Needed - Sport-Tek ST561 Black (XS-XL) *Select Quantity1 - $ 29.462 - $ 58.923 - $ 88.384 - $ 117.845 - $ 147.30Quantity Needed - Sport-Tek ST561 Black (2XL) *Select Quantity1 - $ 31.162 - $ 62.323 - $ 93.484 - $ 124.645 - $ 155.80Quantity Needed - Sport-Tek ST561 Black (3XL) *Select Quantity1 - $ 34.562 - $ 69.123 - $ 103.684 - $ 138.245 - $ 172.80Quantity Needed - Sport-Tek ST561 Black (4XL) *Select Quantity1 - $ 36.262 - $ 72.523 - $ 108.784 - $ 145.045 - $ 181.30Quantity Needed - Sport-Tek ST561 Royal (XS-XL) *Select Quantity1 - $ 29.462 - $ 58.923 - $ 88.384 - $ 117.845 - $ 147.30Quantity Needed - Sport-Tek ST561 Royal (2XL) *Select Quantity1 - $ 31.162 - $ 62.323 - $ 93.484 - $ 124.645 - $ 155.80Quantity Needed - Sport-Tek ST561 Royal (3XL) *Select Quantity1 - $ 34.562 - $ 69.123 - $ 103.684 - $ 138.245 - $ 172.80Quantity Needed - Sport-Tek ST561 Royal (4XL) *Select Quantity1 - $ 36.262 - $ 72.523 - $ 108.784 - $ 145.045 - $ 181.30Quantity Needed - Sport-Tek LST561 Black (XS-XL) *Select Quantity1 - $ 29.462 - $ 58.923 - $ 88.384 - $ 117.845 - $ 147.30Quantity Needed - Sport-Tek LST561 Black (2XL) *Select Quantity1 - $ 31.162 - $ 62.323 - $ 93.484 - $ 124.645 - $ 155.80Quantity Needed - Sport-Tek LST561 Black (3XL) *Select Quantity1 - $ 34.562 - $ 69.123 - $ 103.684 - $ 138.245 - $ 172.80Quantity Needed - Sport-Tek LST561 Black (4XL) *Select Quantity1 - $ 36.262 - $ 72.523 - $ 108.784 - $ 145.045 - $ 181.30Quantity Needed - Sport-Tek LST561 Royal (XS-XL) *Select Quantity1 - $ 29.462 - $ 58.923 - $ 88.384 - $ 117.845 - $ 147.30Quantity Needed - Sport-Tek LST561 Royal (2XL) *Select Quantity1 - $ 31.162 - $ 62.323 - $ 93.484 - $ 124.645 - $ 155.80Quantity Needed - Sport-Tek LST561 Royal (3XL) *Select Quantity1 - $ 34.562 - $ 69.123 - $ 103.684 - $ 138.245 - $ 172.80Quantity Needed - Sport-Tek LST561 Royal (4XL) *Select Quantity1 - $ 36.262 - $ 72.523 - $ 108.784 - $ 145.045 - $ 181.30Quantity 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 - $ 34.852 - $ 69.703 - $ 104.554 - $ 139.405 - $ 174.25Quantity Needed - OGIO Endurance OE335 Electric Blue (XS-XL) *Select Quantity1 - $ 34.852 - $ 69.703 - $ 104.554 - $ 139.405 - $ 174.25Quantity Needed - OGIO Endurance LOE335 Blacktop (XS-XL) *Select Quantity1 - $ 34.852 - $ 69.703 - $ 104.554 - $ 139.405 - $ 174.25Quantity Needed - OGIO Endurance OE335 Blacktop (2XL) *Select Quantity1 - $ 36.552 - $ 73.103 - $ 109.654 - $ 146.205 - $ 182.75Quantity Needed - OGIO Endurance OE335 Electric Blue (2XL) *Select Quantity1 - $ 36.552 - $ 73.103 - $ 109.654 - $ 146.205 - $ 182.75Quantity Needed - OGIO Endurance LOE335 Blacktop (2XL) *Select Quantity1 - $ 36.552 - $ 73.103 - $ 109.654 - $ 146.205 - $ 182.75Quantity Needed - OGIO Endurance OE335 Blacktop (3XL) *Select Quantity1 - $ 39.952 - $ 79.903 - $ 119.854 - $ 159.805 - $ 199.75Quantity Needed - OGIO Endurance OE335 Electric Blue (3XL) *Select Quantity1 - $ 39.952 - $ 79.903 - $ 119.854 - $ 159.805 - $ 199.75Quantity Needed - OGIO Endurance LOE335 Blacktop (3XL) *Select Quantity1 - $ 39.952 - $ 79.903 - $ 119.854 - $ 159.805 - $ 199.75Quantity Needed - OGIO Endurance OE335 Blacktop (4XL) *Select Quantity1 - $ 41.652 - $ 83.303 - $ 124.954 - $ 166.605 - $ 208.25Quantity Needed - OGIO Endurance OE335 Electric Blue (4XL) *Select Quantity1 - $ 41.652 - $ 83.303 - $ 124.954 - $ 166.605 - $ 208.25Quantity Needed - OGIO Endurance LOE335 Blacktop (4XL) *Select Quantity1 - $ 41.652 - $ 83.303 - $ 124.954 - $ 166.605 - $ 208.25Quantity Needed - The North Face NF0A5542 TNF Black (S-XL) *Select Quantity1 - $ 101.002 - $ 202.003 - $ 303.004 - $ 404.005 - $ 505.00Quantity Needed - The North Face NF0A5542 TNF Black (2XL) *Select Quantity1 - $ 102.672 - $ 205.343 - $ 308.014 - $ 410.685 - $ 513.35Quantity Needed - The North Face NF0A5542 TNF Black (3XL) *Select Quantity1 - $ 106.002 - $ 212.003 - $ 318.004 - $ 424.005 - $ 530.00Quantity Needed - The North Face NF0A5543 TNF Black (S-XL) *Select Quantity1 - $ 101.002 - $ 202.003 - $ 303.004 - $ 404.005 - $ 505.00Quantity Needed - The North Face NF0A5543 TNF Black (2XL) *Select Quantity1 - $ 102.672 - $ 205.343 - $ 308.014 - $ 410.685 - $ 513.35Total$ 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-4170EmailSubmit