EmailMe Form - 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.

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