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Shoes for Crews Order Form
Date of Request:
*
MM
/
DD
/
YYYY
Key Code (if applicable)
Associate Name
*
Associate ID (4 digit number)
*
Email
*
Department:
*
Order #1
Please provide the information below for your first pair of shoes.
Style (Numerical Value)
*
Brand
*
Size
*
Width
*
Quantity
Price
*
$
Dollars
.
Cents
Order #2
Please provide the information below for your second pair of shoes. Order #2 is optional and you will be able to complete the order without providing information on a second pair of shoes.
Style (Numerical Value)
Brand
Size
Width
Quantity
Price
$
Dollars
.
Cents
Shipping (per pair of shoes ordered)
$
Dollars
.
Cents
I do hereby understand I will be charged Nebraska Sales Tax @ 7% on this purchase.
*
Please print your name.
I do hereby authorize H&H Automotive LLC to deduct the balance owed on my shoe purchase following the HR Department's receipt of the Shoes for Crews Invoice. If I terminated my position prior to the Shoes for Crews purchase being paid in full, I authorize H&H Automotive LLC to deduct the unpaid balance from my final paycheck. I understand it is my responsibility to return shoes to the Shoes for Crews warehouse if a shoe size change or refund is desired. THIS IS A VOLUNTARY PROGRAM AND IS NOT A CONDITION OF EMPLOYMENT WITH THE COMPANY. VOID WHERE PROHIBITED.
*
Please print your name.
