Shoe Order | Stan Clark Companies

Employee Information

Name*

First Last

Employee ID #*

Phone*

Email*

Company*

Position*

Shoe Information

Shoe Company*

Shoe Name

Style Number

This should be a 4 or 5 digit code. 573 SG is not the style.

Gender*

Men's Shoe
Women's Shoe
N/A (Picked up shoes from Shoe Sensation)

Color*

Size*

Width*

Quantity*

Catalog Price*

The price listed in the catalog excludes tax and shipping (if ordering from Shoes For Crews). Total prices may be less than anticipated due to promotions that are applied.*

By checking this box you are accepting the additional tax and shipping charges.

Voluntary Payroll Deduction Purchase Agreement

I do hereby authorize Stan Clark Companies to deduct the balance owed on my shoe purchase from the number of paychecks specified below. If termination of employment is made prior to the slip-resistant show purchase being paid in full, I authorize Stan Clark Companies to deduct the unpaid balance from my final paycheck. I understand that it is my responsibility to return/exchange all shoes to the appropriate vendor if a size change or refund is desired.

Do you have a company shoe voucher to apply to your purchase?*

No
Yes (PLEASE GIVE VOUCHER TO YOUR MANAGER TO TURN IN)

Do you want to apply a company gift card to this order? If so, please enter your gift card number here:

How much of the gift card would you like to be applied towards your purchase?

Ex.) $10,$50, ALL, etc.

How Many Paychecks to Deduct Shoe Purchase From?*

*If you are applying a gift card, please choose the amount of paychecks you would like to deduct from, in the event the total cost is not covered.

Electronic Signature*

Today's Date*

PLEASE READ AND SIGN THE FOLLOWING*

I understand and agree that my above electronic signature is the legal equivalent of my manual signature. This authorizes The Company to place the above order and withdraw the amount from my paychecks, as specified.

Shoe Order Form

Employee Information

Shoe Information

Voluntary Payroll Deduction Purchase Agreement