Employee Name *

Location *

Muskegon *

Coopersville *

Grandville *

Lowell *

Big Rapids *

Additional Locations *

Reason for Request *

Order Type *

Rental Shirt Style *

Mens
Ladies

Sleeve Length *

Short Sleeve Only
Long Sleeve Only
Mix of Short Sleeve & Long Sleeve

Shirt Size *

Layout

Shirt Size for Short Sleeve *

*Tall sizes are only available in short sleeve styles

Shirt Size for Long Sleeve *

Choose Black, Royal or Both *

Sport-Tek TST650 - Black
Sport-Tek TST650 - Royal
Sport-Tek TST650 - Both

Choose Black, Royal or Both *

Cornerstone CS418 - Black
Cornerstone CS418 - Royal
Cornerstone CS418 - Both

Layout (copy)

Quantity of Royal Short Sleeve *

Quantity of Black Short Sleeve *

Choose Long Sleeve Shirt Style *

Edwards Dress Shirt - E-1975
Cornerstone CS418LS - Royal
Cornerstone CS418LS - Black

Layout

Quantity of E-1975 *

Quantity of CS418LS - Royal *

Quantity of CS418LS -Black *

Total of all long sleeve shirts should equal 11

Choose Shirt Styles *

Edwards Dress Shirt - E-1975
Cornerstone CS418LS - Royal
Cornerstone CS418LS - Black

Sport-Tek TST650 - Royal
Sport-Tek TST650 - Black

Cornerstone CS418 - Royal
Cornerstone CS418 - Black

Layout (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 11

Choose Black, Royal or Both *

Cornerstone CS419 - Black
Cornerstone CS419 - Royal
Cornerstone CS419 - Both

Choose Long Sleeve Shirt Style *

Edwards Dress Shirt - E-5975
Cornerstone CS418LS - Royal
Cornerstone CS418LS - Black

Layout (copy) (copy)

Quantity of E-5975 *

Quantity of CS418LS - Royal *

Quantity of CS418LS - Black *

Choose Shirt Styles *

Cornerstone CS419 - Black
Cornerstone CS419 - Royal
Edwards Dress Shirt - E-5975
Cornerstone CS418LS - Royal
Cornerstone CS418LS - Black

Layout (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 11

Statement of Rental Responsibility

I 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 *

Date *

Purchase Shirt Style *

Mens
Ladies

Product Type (Select All That Apply) *

Polo Shirt
Quarter-Zip Fleece
Vest
Long Sleeve Shirt

Polo Shirt Size *

Polo Shirt Color & Style Selection (Select All That Apply) *

Cornerstone CS418 - Black
Cornerstone CS418 - Royal
OGIO OG125 - Blacktop
OGIO OG125 - Bolt Blue

Polo Shirt Color & Style Selection (Select All That Apply) *

Sport-Tek TST650 - Black
Sport-Tek TST650 - Royal

Quarter-Zip Fleece Color & Style Selection (Select All That Apply) *

Sport-Tek ST561 - Black
Sport-Tek ST561 - Royal
The North Face NF0A3LHB - TNF Black
The North Face NF0A3LHB - Monster Blue
OGIO Endurance OE335 - Blacktop
OGIO Endurance OE335 - Electric Blue

Vest Selection *

The North Face NF0A3LGZ - TNF Black

Long Sleeve Shirt Color & Style Selection (Select All That Apply) *

Edwards Dress Shirt - E-1975
Cornerstone CS418LS - Royal
Cornerstone CS418LS - Black

Polo Shirt Color & Style Selection (Select All That Apply) *

Cornerstone CS419 - Black
Cornerstone CS419 - Royal
OGIO LOG125 - Blacktop
OGIO LOG125 - Bolt Blue

Quarter-Zip Fleece Color & Style Selection (Select All That Apply) *

Sport-Tek LST561 - Black
Sport-Tek LST561 - Royal
The North Face NF0A3LHC - TNF Black
The North Face NF0A3LHC - Monster Blue
OGIO Endurance LOE335 - Blacktop

Vest Selection *

The North Face NF0A3LH1 - TNF Black

Long Sleeve Shirt Color & Style Selection (Select All That Apply) *

Edwards Dress Shirt - E-5975
Cornerstone CS418LS - Royal
Cornerstone CS418LS - Black

Sport-Tek Quarter-Zip Fleece Size *

OGIO Endurance Quarter-Zip Size *

The North Face Quarter-Zip Fleece Size *

The North Face Vest Size *

The North Face Quarter-Zip Fleece Size *

The North Face Vest Size *

Edwards Dress Shirt Size *

Cornerstone Long Sleeve Polo Size *

Quantity Needed - Cornerstone CS418 Black (XS-XL) *

Quantity Needed - Cornerstone CS418 Black (2XL) *

Quantity Needed - Cornerstone CS418 Black (3XL) *

Quantity Needed - Cornerstone CS418 Black (4XL) *

Quantity Needed - Cornerstone CS418 Royal (XS-XL) *

Quantity Needed - Cornerstone CS418 Royal (2XL) *

Quantity Needed - Cornerstone CS418 Royal (3XL) *

Quantity Needed - Cornerstone CS418 Royal (4XL) *

Quantity Needed - OGIO OG125 Blacktop (XS-XL) *

Quantity Needed - OGIO OG125 Blacktop (2XL) *

Quantity Needed - OGIO OG125 Blacktop (3XL) *

Quantity Needed - OGIO OG125 Blacktop (4XL) *

Quantity Needed - OGIO OG125 Bolt Blue (XS-XL) *

Quantity Needed - OGIO OG125 Bolt Blue (2XL) *

Quantity Needed - OGIO OG125 Bolt Blue (3XL) *

Quantity Needed - OGIO OG125 Bolt Blue (4XL) *

Quantity Needed - Cornerstone CS419 Black (XS-XL) *

Quantity Needed - Cornerstone CS419 Black (2XL) *

Quantity Needed - Cornerstone CS419 Black (3XL) *

Quantity Needed - Cornerstone CS419 Black (4XL) *

Quantity Needed - Cornerstone CS419 Royal (XS-XL) *

Quantity Needed - Cornerstone CS419 Royal (2XL) *

Quantity Needed - Cornerstone CS419 Royal (3XL) *

Quantity Needed - Cornerstone CS419 Royal (4XL) *

Quantity Needed - OGIO LOG125 Blacktop (XS-XL) *

Quantity Needed - OGIO LOG125 Blacktop (2XL) *

Quantity Needed - OGIO LOG125 Blacktop (3XL) *

Quantity Needed - OGIO LOG125 Blacktop (4XL) *

Quantity Needed - OGIO LOG125 Bolt Blue (XS-XL) *

Quantity Needed - OGIO LOG125 Bolt Blue (2XL) *

Quantity Needed - OGIO LOG125 Bolt Blue (3XL) *

Quantity Needed - OGIO LOG125 Bolt Blue (4XL) *

Quantity Needed - Sport-Tek TST650 Black (LT) *

Quantity Needed - Sport-Tek TST650 Black (XLT) *

Quantity Needed - Sport-Tek TST650 Black (2XLT) *

Quantity Needed - Sport-Tek TST650 Black (3XLT) *

Quantity Needed - Sport-Tek TST650 Black (4XLT) *

Quantity Needed - Sport-Tek TST650 Royal (LT) *

Quantity Needed - Sport-Tek TST650 Royal (XLT) *

Quantity Needed - Sport-Tek TST650 Royal (2XLT) *

Quantity Needed - Sport-Tek TST650 Royal (3XLT) *

Quantity Needed - Sport-Tek TST650 Royal (4XLT) *

Quantity Needed - Sport-Tek ST561 Black (XS-XL) *

Quantity Needed - Sport-Tek ST561 Black (2XL) *

Quantity Needed - Sport-Tek ST561 Black (3XL) *

Quantity Needed - Sport-Tek ST561 Black (4XL) *

Quantity Needed - Sport-Tek ST561 Royal (XS-XL) *

Quantity Needed - Sport-Tek ST561 Royal (2XL) *

Quantity Needed - Sport-Tek ST561 Royal (3XL) *

Quantity Needed - Sport-Tek ST561 Royal (4XL) *

Quantity Needed - Sport-Tek LST561 Black (XS-XL) *

Quantity Needed - Sport-Tek LST561 Black (2XL) *

Quantity Needed - Sport-Tek LST561 Black (3XL) *

Quantity Needed - Sport-Tek LST561 Black (4XL) *

Quantity Needed - Sport-Tek LST561 Royal (XS-XL) *

Quantity Needed - Sport-Tek LST561 Royal (2XL) *

Quantity Needed - Sport-Tek LST561 Royal (3XL) *

Quantity Needed - Sport-Tek LST561 Royal (4XL) *

Quantity Needed - The North Face NF0A3LHB TNF Black (S-XL) *

Quantity Needed - The North Face NF0A3LHB TNF Black (2XL) *

Quantity Needed - The North Face NF0A3LHB TNF Black (3XL) *

Quantity Needed - The North Face NF0A3LHB Monster Blue (S-XL) *

Quantity Needed - The North Face NF0A3LHB Monster Blue (2XL) *

Quantity Needed - The North Face NF0A3LHB Monster Blue (3XL) *

Quantity Needed - The North Face NF0A3LHC TNF Black (S-XL) *

Quantity Needed - The North Face NF0A3LHC TNF Black (2XL) *

Quantity Needed - The North Face NF0A3LHC Monster Blue (S-XL) *

Quantity Needed - The North Face NF0A3LHC Monster Blue (2XL) *

Quantity Needed - OGIO Endurance OE335 Blacktop (XS-XL) *

Quantity Needed - OGIO Endurance OE335 Electric Blue (XS-XL) *

Quantity Needed - OGIO Endurance LOE335 Blacktop (XS-XL) *

Quantity Needed - OGIO Endurance OE335 Blacktop (2XL) *

Quantity Needed - OGIO Endurance OE335 Electric Blue (2XL) *

Quantity Needed - OGIO Endurance LOE335 Blacktop (2XL) *

Quantity Needed - OGIO Endurance OE335 Blacktop (3XL) *

Quantity Needed - OGIO Endurance OE335 Electric Blue (3XL) *

Quantity Needed - OGIO Endurance LOE335 Blacktop (3XL) *

Quantity Needed - OGIO Endurance OE335 Blacktop (4XL) *

Quantity Needed - OGIO Endurance OE335 Electric Blue (4XL) *

Quantity Needed - OGIO Endurance LOE335 Blacktop (4XL) *

Quantity Needed - The North Face NF0A3LGZ TNF Black (S-XL) *

Quantity Needed - The North Face NF0A3LGZ TNF Black (2XL) *

Quantity Needed - The North Face NF0A3LGZ TNF Black (3XL) *

Quantity Needed - The North Face NF0ALH1 TNF Black (S-XL) *

Quantity Needed - The North Face NF0ALH1 TNF Black (2XL) *

Quantity Needed - Cornerstone CS418LS Royal (XS-XL) *

Quantity Needed - Cornerstone CS418LS Royal (2XL) *

Quantity Needed - Cornerstone CS418LS Royal (3XL) *

Quantity Needed - Cornerstone CS418LS Royal (4XL) *

Quantity Needed - Cornerstone CS418LS Black (XS-XL) *

Quantity Needed - Cornerstone CS418LS Black (2XL) *

Quantity Needed - Cornerstone CS418LS Black (3XL) *

Quantity Needed - Cornerstone CS418LS Black (4XL) *

Quantity Needed - Edwards Dress Shirt E-1975 (S-XL) *

Quantity Needed - Edwards Dress Shirt E-1975 (LT, XLT, 2XL, 2XLT) *

Quantity Needed - Edwards Dress Shirt E-1975 (3XL, 3XLT, 4XLT) *

Quantity Needed - Edwards Dress Shirt E-1975 (5XLT, 6XLT) *

Quantity Needed - Edwards Dress Shirt E-5975 (XXS-XL) *

Quantity Needed - Edwards Dress Shirt E-5975 (2XL) *

Quantity Needed - Edwards Dress Shirt E-5975 (3XL) *

Total

$ 0.00

Statement 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 below

Date *

Amount Paid *

Date *

Date

Employee Signature *

Date *

Transfer from *

Muskegon *

Coopersville *

Grandville *

Lowell *

Big Rapids *

Transfer to *

Muskegon *

Coopersville *

Grandville *

Lowell *

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