Shoe Order Form

  • Employee Information

  • Shoe Information

  • This should be a 4 or 5 digit code. 573 SG is not the style.
  • 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.
  • Ex.) $10,$50, ALL, etc.
  • *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.
  • MM slash DD slash YYYY